The Children’s Movement of Florida, a group of prominent leaders across the state who care about the future of children, is gaining momentum.

The non-partisan, citizen-led organization is hosting a series of “Milk Party” rallies in various cities (click here to read more). Alliance members are encouraged to attend and invite patients and their families.

The top two priorities of the Children’s Movement are right in line with those of the Alliance: making sure children have access to health insurance; and screening, treatment and services for healthy child development.

Below is a schedule of the Milk Party rallies.

Monday, Sept. 6 (Labor Day) - Pensacola
Time: 10 to 11 a.m. - Doors open at 9:30 a.m.
Location: Pensacola High School
Contact: Audra Carter - audra.carter@childrensmovementflorida.org

Tuesday, Sept. 7 - Panama City
Time: 9 to 10 a.m. (Community Discussion)
Location: Bay District Schools Headquarters
Contact: Margaret Tidmore - tidmoma@bay.k12.fl.us

Tuesday, Sept. 7 - Tallahassee
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Tallahassee-Leon County Civic Center
Contact: David Abrams - david.abrams@childrensmovementflorida.org

Wednesday, Sept. 8 - Gainesville and Ocala
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Santa Fe College
Contact: David Abrams - david.abrams@childrensmovementflorida.org

Monday, Sept. 13 - Daytona Beach (Volusia and Flagler Counties)
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Mainland High School Performing Arts Center
Contact: Leah Shepherd - leah.shepherd@childrensmovementflorida.org

Tuesday, Sept. 14 - Orlando and Kissimmee
Time: 6:30 to 7:30 p.m. - Doors open at 6 p.m.
Location: Dr. Phillips High School
Contact: Leah Shepherd - leah.shepherd@childrensmovementflorida.org

Wednesday, Sept. 15 - Treasure Coast (St. Lucie, Martin and Indian River Counties)
Time: 6:30 to 7:30 p.m. - Doors open at 6 p.m.
Location: Fort Pierce Central High School
Contact: Kerline Boursiquot - kerline.boursiquot@childrensmovementflorida.org

Thursday, Sept. 16 - Tampa
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Tampa’s Lowry Park Zoo
Contact: Adam Brown - adam.brown@childrensmovementflorida.org

Friday, Sept. 17 - Lakeland
Time: 10 a.m. to noon - Doors open at 9:30 a.m. (Mini-rally)
Location: Common Ground Park
Contact: Shawna Butler - shawna.butler@uwcf.org

Monday, Sept. 20 - St. Petersburg
Time: 6:30 to 7:30 p.m. - Doors open at 6 p.m.
Location: Calvary Chapel St. Petersburg
Contact: Adam Brown - adam.brown@childrensmovementflorida.org

Tuesday, Sept. 21 - Sarasota and Bradenton
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Riverview High School
Contact: Cheray Keyes-Shima - cheray.shima@childrensmovementflorida.org
Seana Mincy - seana.mincy@childrensmovementflorida.org

Wednesday, Sept. 22 - Naples and Fort Myers
Time: 6:30 to 7:30 p.m. - Doors open at 6 p.m.
Location: Seacrest Country Day School
Contact: Becky Newell - becky.newell@childrensmovementflorida.org

Thursday, Sept. 23 - West Palm Beach
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: The Harriet Himmel Theater at CityPlace
Contact: Kerline Boursiquot - kerline.boursiquot@childrensmovementflorida.org

Monday, Sept. 27 - Jacksonville
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Ritz Theatre & La Villa Museum
Contact: Amy Rankin - arankin@smag.com

Tuesday, Sept. 28 - Ft. Lauderdale and Broward
Time: 7 to 8 p.m. - Doors open at 6:30 p.m.
Location: Bailey Concert Hall at Broward College (Central Campus)
Contact: Pam Gadinsky - pam.gadinsky@childrensmovementflorida.org

Wednesday, Sept. 29 - Miami-Dade County
Time: 6:30 to 7:30 p.m. - Doors open at 6 p.m.
Location: Miami-Dade County Auditorium
Contact: John Knight - john.knight@childrensmovementflorida.org

Thursday, Sept. 30 - Key West
Time: 6 to 7 p.m. - Doors open at 5:30 p.m.
Location: Key West High School
Contact: Kelli Brower - kelli.brower@childrensmovementflorida.org

This news release is from Florida CHAIN. Thanks to CHAIN, Florida Legal Services and Holland & Knight for pursuing this case against TRS.

FOR IMMEDIATE RELEASE August 24, 2010

Contact: Laura Goodhue, Executive Director, Florida CHAIN 561-972-4090 Miriam Harmatz, Senior Attorney, Florida Legal Services 305-573-0092 ext. 206; 786-853-9385

Lawsuit Filed to Increase Transparency in
Medicaid Managed Care

MIAMI– Holland and Knight Partners Sandy Bohrer and Scott Ponce, along with Miriam Harmatz of Florida Legal Services, filed a lawsuit today in Miami Dade Circuit Court alleging that a Medicaid HMO subcontractor is refusing to comply with the state’s public records law.

The defendant, Therapy Review Systems (TRS), receives public funds to provide medically necessary therapy services to children on Medicaid. The lawsuit was filed on behalf of Florida CHAIN (Community Health Action Network), a not-for-profit grass roots organization that works on issues relating to low income access to health care.

For the last year Florida CHAIN and Florida Legal Servcies (FLS) have been unsuccessfully attempting to obtain public records from TRS. The requests relate to the percentage of public money that TRS actually spent on health care services compared to the amount spent on administrative costs, including salaries and profits. This percentage is also referred to as “medical loss ratio” or (”MLR”).

According to Laura Goodhue, Executive Director of CHAIN, the lawsuit underscores the need for MLR requirements since they “help ensure transparency and accountability. Further, it is critical that sick and impoverished Florida Medicaid recipients receive medically necessary care from their HMOs. If the HMOs or their subcontractors are spending more than 15% or 20% of the public dollars they receive for administrative and profit related expenses, they are simply not going to have enough money to cover necessary direct health care services.”

Although the recent federal health reform legislation requires that insurance companies in the private market spend between 80% and 85% of premium dollars on direct care for enrollees, it does not specifically apply to Medicaid HMOs.

While TRS claims that they are not subject to the state’s public records law since they contract with a Medicaid HMO rather than directly with the state, FLS attorney Miriam Harmatz states that “consumers and taxpayers have a right to know that public dollars devoted to Medicaid services for low income Floridians are actually being spent on health care services. The Public Records Act should not be circumvented because the HMO delegated its responsibility to provide medically necessary therapy services to another private contractor.”

Lead Counsel Sandy Bohrer and Scott Ponce, both of whom are experts on Florida’s Public Records Act, took the case pro bono.

Times-Union
Aug. 22

By Brandon Larrabee

TALLAHASSEE - With state budget-writers likely to face a shortfall of $6 billion or more in the next budget year, the incoming governor is likely to face the question of how to control Medicaid spending.

The state-federal program, which provides health care for low-income Floridians, is consuming an ever higher share of state spending. Legislative figures show Medicaid spending growing from 18 percent of the state budget in the 1998-99 fiscal year to 26 percent in 2009-10. It’s projected to reach 36 percent in a decade.

Republican gubernatorial candidate Rick Scott has proposed creating a voucher system that would allow recipients to buy their own insurance. His opponent, Attorney General Bill McCollum, plans to create savings through better managed care.

Some efforts to rein in the cost in Florida are already under way. Former Gov. Jeb Bush pushed through a Medicaid reform pilot program based on managed care, implemented in 2006 for Duval and Broward counties and in 2007 for Baker, Clay and Nassau counties.

The Legislature will also have a say on the way forward, and lawmakers balked at expanding that program in 2011, when it was tentatively slated to go statewide. House leaders wanted a plan that would have eventually brought the entire state’s Medicaid population into a revamped version of the managed-care system; senators pushed an extension of Bush’s reform plan to 19 additional counties. Some advocates are nervous about expanding the plan.

The proposal from the Scott campaign would be a fundamental shift in how care is provided.

“Rick would like to seek a Medicaid waiver in order to allow Florida to create a voucher program in which Medicaid recipients would be able to shop for insurance in the private market and purchase an insurance option that fits their needs,” said Trey Stapleton, a campaign spokesman.

Senators approved, allowing the state’s Agency for Health Care Administration to seek a waiver in their budget for the current fiscal year, but it was ultimately left out of the compromise spending plan with the House.

“If we were not able get that waiver, Rick would seek to expand, statewide, the current Medicaid reform pilot program that was created by Gov. Bush in 2005,” Stapleton said.

The Scott campaign points to a study by researchers at the University of Florida that suggests the program cut costs and improved outcomes.

Combined with changes to health care for state employees, the Scott campaign estimates his plan will save taxpayers $1.8 billion.

Figures by legislative staff compiled in the run-up to the past legislative session seem to suggest that care coordinated either by doctors or managed-care providers can reduce costs. Patients with coordinated care cost the state an average of $3,479 in 2008, compared with an average of $13,320 for those outside of the programs.

Those results are at the heart of McCollum’s plan.

“Better coordination through a primary care physician not only prevents the duplication of services but also the use of unnecessary services,” the attorney general says in his health care blueprint.

McCollum also lays out a half-dozen “principles” for his plan, from providing choices to Medicaid patients to measuring medical results and rewarding patients who take steps to manage their health. He also pledges not to cut rates to medical providers and says cost savings for health care plans should be shared with doctors.

The Florida Medical Association, which endorsed McCollum, has praised his plan - particularly the attention paid to providers’ rates.

“The Attorney General’s health care plan addresses Florida’s low Medicaid reimbursement rates, which have limited physicians’ ability to participate in the program,” Tim Stapleton, the FMA’s executive vice president, said in a statement when McCollum’s plan was released.

McCollum also promises to crack down on Medicaid fraud.

brandon.larrabee@jacksonville.com, (678) 977-3709

From the Coalition of McKay Scholarship Schools:

Under a new law, private school students who have attended public school since 2005 — but have not received state funds — can qualify for McKay Scholarships.

Also, students who have a current IEP, have a disability and can be identified through Child Find are also eligible for the scholarships, regardless of whether they attended a public school last year.

To learn more about the new law, go the the Coalition’s website at www.mckaycoalition.com.

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.

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.

From News Service Florida

Calls for a veto of a far-reaching Medicaid overhaul awaiting a Senate vote poured in Wednesday as Gov. Charlie Crist acknowledged he too has concerns about the proposal.

Crist met Wednesday with two representatives of AARP, who told the governor the senior lobby is strongly against the legislation. “

“It’s such a huge reform proposed in the waning days of the Legislature,” said Leslie Spencer, one of two AARP officials who met with Crist. The group’s main concern is a House bill’s shifting of nursing home patients into managed care programs. “”It’s a big change,” said Spencer, who added that Crist didn’t give any indication of his thoughts on two companion bills, which have passed the House, but are awaiting Senate approval (HB 7223, HB 7225).

Crist did weigh in a bit, however, earlier in the day, acknowledging that he also is concerned. “I have some concerns about it,” Crist said. “I want to make sure whatever is passed doesn’t unfairly treat the most vulnerable in our society as well as our senior citizens.”

Meanwhile, more than 100 nurses planned to come to the Capitol on Thursday to urge Crist to veto the legislation, even as it awaits a Senate vote. “

“Low income children, the developmentally disabled, pregnant women and seniors would face delays and denials in care if they are forced into for-profit, managed-care Medicaid,” the Service Employees International Union, which represents many nurses, said in a statement announcing its opposition to the proposal.

It appears that the Agency for Health Care Administration is ready to move forward with a new utilization management program for therapy services provided to Medicaid-eligible children.

The previous model, called the Prepaid Therapy Program, ”is no longer being planned for implementation,” according to the agency’s website.  It further reads:

“The Agency has rejected all bids on this proposal and is exploring other options for complying with the statutory mandate to implement a utilization management program for Medicaid Therapy Services.”

Three years ago, the agency had selected two private companies to carry out the Prepaid Therapy Program, which would have required thousands of Medicaid children to enroll in a special therapy-only plan in order to receive OT, PT, speech and respiratory services. But as details of the plan and the backgrounds of the vendors emerged, the pediatric therapy community expressed their concerns about the program’s effectiveness. 

Earlier this year, the agency’s Chief of Staff Tom Arnold announced in a legislative committee hearing that AHCA would not move forward with the program due to concerns about the vendors — American Therapy Administrators (ATA) and Therapy Review Systems (TRS). The vendors filed protests against the agency’s decision to drop the program. AHCA’s website indicates those issues have since been resolved. 

The Alliance for Pediatric Therapies looks forward to collaborating with the agency and other organizations to develop a viable utilization management program.

 You can read more about the Prepaid Therapies Program and the controversy in our archives.

Update: Last week, AHCA’s Tom Arnold told the Senate Health and Human Services Appropriations Committee that his agency had concern’s about the contractors’ experience and ability to carry out this contract. Sen. Durell Peaden stated that he is still interested in a utilization management program for pediatric therapies, but did not specifically say it had to be the Prepaid Therapies Program. 

After nearly two years of mounting opposition, the Agency for Health Care for Administration is terminating the controversial Prepaid Therapies Program.

It would have required thousands of Medicaid-eligible children to enroll in special health plans in order to get physical, occupational and speech therapies. The program was largely developed by a therapy management company and its representatives, who quietly got a bill passed in 2003 forcing AHCA to conduct a “utilization management” program of Medicaid therapies.

AHCA bid out the contract several times, with two sets of vendors fighting over it. In 2006, AHCA announced its decision to split the contract between them.

South Florida-based Care Access Health Plan would enroll children in the northern part of the state. Its subcontractor American Therapy Administrators of Florida would review Medicaid therapy services (Read more here about the owners of ATA, who once owned a Wisconsin-based company that administered Medicaid dental payments). Companion Care, a subsidiary of Blue Cross Blue Shield of South Carolina, would enroll children in the southern part of the state and put therapy management in the hands of its subcontractor, TRS.

The Alliance for Pediatric Therapies has voiced strong opposition to the program and its potential for taking away medically necessary therapy services for children.

During a 2007 forum at Nova Southeastern University, the therapy management company behind the program touted it as a way to save millions of dollars in “rampant fraud” and “overutilization” of services ordered by therapists. This “fraud” was based on their own studies.

AHCA already has the ability to target fraudulent providers. Also, the state’s most recent Medicaid fraud report identifies no fraud by pediatric therapists.

Under the Prepaid Therapies Program, AHCA would give each vendor a fixed amount of money to manage pediatric therapies. The funding, however, reflected a 20 percent spending reduction. The vendors would get 3 percent for profit and use another 12 to 15 percent for administrative costs, according to their presentation last April in Tampa. That’s a 38 percent funding cut. 

Originally, the number of children targeted for the program was about 700,000. In recent years, more Medicaid HMOs have come into the market, leaving far fewer children for the Prepaid Therapies Program. This brought into question the financial viability of the program and its potential for cost savings.

AHCA has been looking into complaints that TRS — which ”manages” pediatric therapies for the Amerigroup Medicaid HMO — has denied legitimate therapies to children.  TRS evaluators claim the services are not medically necessary and refer children to the school system or the Early Steps.

After careful consideration, AHCA officials decided not to proceed with the Prepaid Therapies Program contracts and rejected the bids from both sets of vendors. One of the vendors has already filed a protest.

We are thankful for AHCA Secretary Holly Benson and her staff for listening to the concerns of the Alliance and hundreds of parents, children and therapists.

Although state law still orders AHCA to put in place a therapy utilization management program, the agency is moving in another direction. It is unclear what the new program will look like. In the meantime, we will closely monitor the vendors and their lobbying corps during the legislative session that is currently underway.

By the Alliance for Pediatric Therapies

The Prepaid Therapies Program has been postponed until Spring 2009, according to the Agency for Health Care Administration. The agency has set no specific date at this time.

This means that the program, which would allow two outside vendors to review and approve/deny Medicaid therapy services for children, will not go into effect Feb. 1.

There are many questions surrounding the need for this program and whether it will benefit the vendors at the expense of therapy services to children. When the program was first envisioned by the vendors six years ago, the number of Medicaid children that would be moved into the program was 700,000.

Since then, the majority of these children have been shifted into Medicaid HMOs or Medicaid reform plans, bringing the number down to at least 240,000. That brings additional questions about the cost-effectiveness of the program. The Alliance for Pediatric Therapies is pleased that these questions are being reviewed and the program has been posponed again.

Its original state date was Sept. 1, 2008, but AHCA took pause after hearing numerous valid concerns from individuals and organizations including the Alliance, which represents pediatic therapy practices, and professional organizations that represent individual therapists.