The Agency for Persons with Disabilities is thinking about scrapping the way it delivers services to developmentally disabled Floridians and their families.

In 2007 and 2008, the Legislature ordered APD to reduce its deficit and whittle down its waiting list of individuals by putting them in categories, or “tiers,” based on the level of services they need. Each category has a spending limit per person.

As a result, thousands of individuals had reductions in services, triggering more than 5,000 appeals filed with APD.

Agency director Jim DeBeaugrine has been discussing with legislators the possibility of changing the tier systems, according to the Tampa Tribune:

“DeBeaugrine raised the prospect of setting fixed budgets for each beneficiary instead, based on a formal assessment of their needs and family circumstances.”  Read more here.

The Louisiana Legislature gave its governor approval to move forward with plans to overhaul the state’s Medicaid plan.

Gov. Bobby Jindal now goes to the Bush administration to seek federal approval.

From the Associated Press:

“Jindal proposes the managed care networks as a pilot program in four parts of the state: the New Orleans, Baton Rouge, Lake Charles and Shreveport areas.

“About 380,000 low-income residents in Medicaid, mostly children, would be steered into the managed care networks that state Health and Hospitals Secretary Alan Levine said he hopes would begin operating by the end of 2010,” according to a story by the Associated Press.

“The networks would be run by private management companies, like insurers, that would contract with the state and negotiate payment prices with health providers. The managed care plans could vary the benefit packages and care received by Medicaid recipients.”

It appears to be a mirror image of Florida’s limited Medicaid Reform plan in five counties. Levine is the former secretary of the Agency for Health Care Administration. He was in charge of that agency’s plans to reform Florida’s Medicaid program under then-Gov. Jeb Bush.

Agency for Health Care Administration officials announced in a conference call Friday that they will not require MediPass patients to jump through additional hoops in order to re-enroll in the health care program.

A new law (HB 5085) passed during the 2008 Legislature would have required MediPass patients to contact AHCA during their re-enrollment period each year and state that they want to remain in MediPass.  Patients who didn’t do so would have been removed from MediPass and placed in a Medicaid HMO.

AHCA officials calculated the cost of notifying thousands of MediPass patients would cost at least $600,000.

After discussions with the federal Centers for Medicaid and Medicare as well state legislators, AHCA officials decided not to pursue the enrollment change — even though the agency is mandated by law to do so.

Beneficiaries will still get a letter notifying them of their annual 60-day re-enrollment window, during which time they can switch to a Medicaid HMO. But they will automatically be re-enrolled in MediPass if they don’t respond to their re-enrollment letter from the state.

Announcement from the Florida Child Health Care Coalition

KidCare Child Health Connect

In an effort to help the many families who have experienced problems with enrollment and renewal of KidCare health care coverage during the last several months, the KidCare Child Health Connect project has been launched. Regional community KidCare advocates and partners will now be available to assist you with family account and communication issues.  This process will serve to; help families, track and resolve specific systemic issues, and reduce the duplication of efforts by individuals.

You can help families by sending individual stories and issues to the key contacts listed below.  Special staff will be responsible for contacting families with solutions within 24 hours.   This safety net assistance process should only be utilized if the family has first tried to call the KidCare 800 number first.

Please review the following   purpose and process for this advocacy action network, and the list of available community connectors who are  assisting families with KidCare.

Background

The Florida KidCare Program has successfully covered hundreds of thousands of previously uninsured children in Florida since its inception in 1988.  In May of 2008, the Florida Healthy Kids Corporation’s new third party administrator, Affiliated Computer Systems, Inc., took over the complex role of enrolling, renewing and processing applications and accounts for the Title XXI components of the Program.

As with any large scale transition, families began encountering problems. Such problems included a lack of communications, families’ inability to reach assistance through the call center due to high call volumes, and delays in processing renewal applications. The staff of Healthy Kids, Children’s Medical Services Network, MediKids, and ACS all worked to correct these issues on an individual basis. Community outreach workers, advocates and families also continued to report some issues.  As a result, a large number of enrollees lost their coverage or saw their enrollment into the Program delayed.

In recognition of these challenges, the Florida Healthy Kids Corporation’s board of directors directed its staff to implement a disenrollment suspension project to ensure that no child is inappropriately disenrolled from the program due to a system error.  This project went into effect October 1, 2008.  For the month of October, this project ensured that no child lost coverage due to lack of a required premium payment or for failure to complete the renewal process where it had been initiated but not completed.  Each month, Healthy Kids staff carefully reviews the TPA’s progress and adjusts the project’s target to address any continuing or ongoing issue that would impact a child’s enrollment.  A vigorous corrective action plan with the third party administrator is also in effect through the end of February 2009.

As the corrective action plan is implemented, a temporary advocate resource network - KidCare Child Health Connect - has been created to assist families during this transition period.  Fifteen (15) advocates from throughout the state have been identified to participate in this process through March 2009.  These individuals represent a wide variety of constituencies who have frequent contact with families and who conduct outreach on an ongoing basis.

Purpose of KidCare Child Health Connect:

• To help families who have been unable to get a problem resolved through use of the call center.
• Establish a mechanism for tracking system issues and to identify areas for corrective action.
• Reduce duplication of effort as specific staff will be assigned to this project.

This process is not meant to replace or divert families from first using the KidCare Customer Service Hotline (1-800-821-5437) to resolve their questions or complaints. Families and /or community partners should only utilize this process after the family has attempted to resolve their issues via the call center.

All Children’s Medical Services Network families are to continue to be referred directly to their local CMS Network office for assistance.

The KidCare Child Health Connect Network participants will have access to a special web-based system where issues and concerns regarding specific family accounts can be entered.  Specially assigned Healthy Kids staff will monitor these messages and contact will be initiated with the family within 24 hours.  For confidentiality reasons, the KidCare Health Connect Network participants will receive only an email acknowledgement that the issue has been received and is being reviewed.

In an effort to maximize the resources available, the following regional representatives are available to assist you with any family account issue.

Broward Rebecca Miele Rebecca_Miele@doh.state.fl.us

Volusia/Flagler Steve Parris steven.parris@halifax.org

Orange/Seminole Dawn Steward Dawn@Healthystartorange.org

St. Lucie Danny  Pierre-Louis ruthpierrelouis1@hotmail.com

Miami Fay Maturah FMaturah2@jhsmiami.org

Lucia Jeff LJeff@jhsmiami.org

Duval Jack Johnson jjohnson@nefhsc.org

Brevard Susan Macuska susan.macuska@health-first.og

Okeechobee Sharon Vinson VinsonS@okee.k12.fl.us

Escambia/Santa Rosa Stacy Ray s_ray@familiescount.net

Florida CHAIN Laura Goodhue laurag@floridachain.org

Hillsborough Marisa Rappa Marisa.Rappa@baycare.org

CKF Jodi Ray jray@health.usf.edu

Florida Child Health Coalition Linda Merrell LindaKids1@aol.com

Karen Woodall fcfep@yahoo.com

In response to the autism/insurance legislation that passed earlier this year, a workgroup on Wednesday approved agreement language that would require large health plans to cover diagnosis and treatment for autism and development disabilities.

Click here to read the agreement that was proposed by Sen. Andy Gardiner. The agreement, called the Developmental Disabilities Compact,  has a couple of catches:

• It only apples to large health plans, not small group or self-insured plans which enroll the vast majority (about 85 percent) of families in Florida.

• Large health plans don’t have to sign it — and probably won’t.

What does the compact require?

It requires large health plans to cover applied behavior analysis as well as occupational, speech and physical therapies for individuals diagnosed with autism and developmental disabilities when determined to be medically necessary.

Children must be diagnosed by age 8 in order to be covered. The compact caps benefits at $36,000 a year or $200,000 for a lifetime.

What is “medically necessary”?

This definition is very controversial within the health care industry. In this compact, it means a a covered service that will, or is reasonably expected to accomplish one or more of the following — Arrive at a correct medical diagnosis; Prevent the onset of an illness, condition, injury, or disability; Reduce, correct, or ameliorate the physical, mental, developmental, or behavioral affects of an illness, condition, injury, or disability;  Assist in the achievement or maintenance of sufficient functional capacity to perform age-appropriate or developmentally appropriate daily activities.

What happens if health plans don’t sign the compact?

The law (SB 2654) states they have to offer applied behavior analysis, occupational, physical and speech therapies only to children with autism spectrum disorder — not developmental disabilities. There will likely be efforts during the 2009 Legislature to expand the law to force coverage of services for children with developmental disabilities. We will post the proposed legislation on our website.

We will have an additional analysis shortly.

Florida’s Interagency Coordinating Council for Infants & Toddlers (FICCIT) is seeking membership applications from an important group — parents.

FICCIT is a federally mandated council that makes sure public and private services are available for children with developmental delays, or those with conditions that could lead to developmental delays.

FICCIT  is made up of individuals who work for state agencies that provide health care, preschool and early intervention services such as Early Steps. Membership also includes service providers and parents.

Parental participation on FICCIT is vital, according its website www.floridaicc.com:

“They are the ones who must navigate the state’s system on behalf of their children and see first-hand what works and what doesn’t… If your child receives early intervention services, or has received such services in the past five years, please consider applying for appointment to FICCIT. “

FICCIT holds quarterly meetings across the state. Members are reimbursed for their travel expenses, and respite care is available. Its next meeting will take place late January in Tallahassee. Details will be posted in the near future on our calendar.

For more information about FICCIT or to apply for membership, visit the website or contact Council Chairwoman Randee Gabriel at rgabriell@arcpbc.org.

PRESS RELEASE –

TALLAHASSEE - Governor Charlie Crist today announced the creation of My ACCESS Account, a system that allows food stamp, temporary cash assistance and Medicaid applicants and recipients to check the status of their case online, 24-hours a day, seven days a week. Governor Crist was joined by George Sheldon, Secretary of the Department of Children and Families, to unveil the account management program which empowers customers with information about their public assistance benefits at their convenience.

“As we continue to work to make the most of state resources, it is encouraging to see state agencies finding new and practical ways to improve customer service for Floridians,” said Governor Crist. “Through the My ACCESS account system, we are providing so much more than a service. We are giving Floridians peace of mind.”

My ACCESS Account users can check account status, view current benefits, check the date benefits will be available, and print a temporary Medicaid card. Users can also view information regarding their appointments, verifications that may be needed to determine eligibility, a history of benefits and other important information regarding their case. To register for My ACCESS Account, visit www.myflorida.com/accessflorida. The information is available only to individual users who will log onto a secure account with a private, protected username and password.

“Every day the Department works to provide the best customer service to our customers and My ACCESS Account is another important tool to help us do just that,” said Secretary Sheldon. “Our current economy and the ongoing needs of our clients only reinforce the importance of our programs and we’re proud to work with Governor Crist to serve those in need.”

Today, more Floridians are applying for and receiving public assistance than ever before. In November, 1.7 million people received food stamps; 91,000 people received Temporary Assistance for Needy Families cash benefits; and 1.8 million individuals received Medicaid. The U.S. Department of Agriculture recently reported that Florida has experienced the highest food stamp caseload increase in the nation, now 45 percent above the April 2007 level. With My ACCESS Account, the millions who receive assistance can get information about their account, whenever they need it.

ACCESS Florida is the modernized public assistance system that provides Food Stamps, Medicaid, and temporary cash assistance to families in need. Continuous improvements to the system have been used as a model for social service agencies nationwide. The U.S. Department of Agriculture recently awarded the Department a $5.4 million bonus for having the most improved food stamp error rate in the nation.

Individuals who wish to apply for assistance can call 1-866-76ACCES (1-866-762-2237). They can also apply online at www.myflorida.com/accessflorida, or visit one of the program’s 3,300 community partner sites.

For more information about the Department of Children and Families’ ACCESS Florida program, visit http://www.dcf.state.fl.us/ess/.

Two reports released last week cast doubt on Florida’s Medicaid Reform pilot project and bring into question whether it should be expanded from five counties to all 67.

Georgetown University’s Health Policy Institute has released its final report of Medicaid Reform after nearly two years of study.

“Two years after the launch of Florida’s Medicaid reform pilot it appears that beneficiaries’ access to heath care has worsened and financial benefits for the State of Florida remain unknown,”  according to the news release issued by the Institute.

A second report released by the Florida Legislature’s Office of Program Policy Analysis and Government Accountability states that:

• Information available to Reform beneficiaries about providers participating in Reform plans is not always accurate.
• Some beneficiaries have experienced difficulty selecting a plan that meets their needs and ensures that they can make appointments to see specialty providers.
• There is conflicting evidence to support whether access to specialty providers has improved or not in the Reform counties.
• AHCA should develop additional Reform contract requirements as well as improve its oversight of provider networks.

The Medicaid Reform pilot project was promoted by Gov. Jeb Bush during his tenure and was shepherded in the Legislature by then-Rep. Holly Benson. She is now the Secretary of the Agency for Health Care Administration and will ask the Legislature in 2009 to expand the program from the five counties in which it exists.

State law currently mandates that the program must be statewide by 2010. Any changes to this law will have to be addressed by the state Legislature during the 2009 session that begins March 2. The issue will certainly dominate health care-related discussions at the Capitol.

The findings provide additional ammunition to critics who say the program has failed to achieve its goals of better health care delivery in a cost-effective manner.

Georgetown University’s study notes, “The complexity of the program has grown, causing confusion and increased administrative burdens for consumers and providers. Access to needed services appears to be worsening according to both physicians and beneficiaries, and provider participation is declining.”

This editorial was written by former Gov. Jeb Bush and calls for the expansion of Medicaid reform. It is in response to an earlier editorial that the Tampa Tribune published that criticized the Medicaid reform experiment. Gov. Bush pursued this initiative while he was in office.

By JEB BUSH

Special to the Tribune

Published: November 29, 2008

In 2006, Florida launched the first substantial reform of Medicaid since the program was originated more than three decades ago. The goals of reform were to improve the quality of health care provided to 2.2 million poor, elderly and disabled citizens under the state-federal program and to control skyrocketing costs that threatened the sustainability of this important program.

The tenets of the reform are simple. New Medicaid is a patient-centered system that respects individual participants by empowering them to direct their own health care. It provides choices, promotes preventive care, reduces inefficiency and prevents fraud. Most importantly, the reform plan harnesses the power of the marketplace to foster innovation and spur competition, which improves the quality of care for our most vulnerable Floridians and drives down the costs to taxpayers who are paying the medical bills.

Questioning The Progress

Recently, a flawed study published in Health Affairs Web Exclusive and a misleading Tampa Tribune editorial questioned the progress made in the implementation of Florida’s bold reform and the wisdom in continuing it.

Now expanded to five counties, 220,000 beneficiaries are currently participating in the pilot program. That’s just 9 percent of the program’s participation but more than the entire Medicaid enrollment in 12 states. Just 29 months in, Medicaid reform can claim significant successes.

Under reform, we get more for less. Without an increase in premiums, new services are now available to Medicaid recipients, including wellness checks, dental services and coverage for over-the-counter medications. The number of plans available has nearly doubled, with more than 80 percent of participants making their own informed decisions. The amount of the state’s contribution reflects the medical needs of each consumer instead of a cumbersome, one-size-fits-all program that was too much for some patients and too little for others. To this end, the first-ever specialty plan will soon be available in one of the pilot counties - a plan specifically tailored to meet the health care needs of HIV/AIDS patients.

Why The Reforms Work

Critics cleverly use problems and popular complaints already inherent in today’s health care system to discredit and undermine reform policies. First, government will always rely on private companies to ultimately deliver care to patients - the state is the payer, not the provider. We can always do a better job of rooting out fraud, waste and mismanagement, but a government takeover is not the answer, since government interference and mandates are what led to the problems we have today.

Second, managed health care companies make less under reform because they are no longer paid the same for healthy and chronically ill people. Providers are only paid for the services actually required by the individuals in the plan, not an expansive and expensive menu of services never utilized by healthy patients. This shifting of resources may explain why three organizations recently threatened to drop out of the pilot plan - a sign of success, not failure.

Third, with taxpayers footing the bill, it is impossible to insulate Medicaid - old or new - from downturns in the economy and subsequent revenue shortfalls and budget cuts. Reductions in Medicaid rates have nothing to do with reform. Rate reductions for the current fiscal year apply to all providers both in and out of the pilot communities.

Lastly, we can’t pretend there is a one reform or solution that will deliver everything to everyone. Every health system imposes limits. The improvement in Medicaid reform is that financial incentives are given to managed care organizations to keep people healthy and make sick people better.

Old Program Was Costly

Without reform, Medicaid is unsustainable. In less than a decade, the traditional Medicaid program would consume nearly 60 percent of the state’s budget - leaving little left for spending on education, infrastructure or public safety. Eventually, lawmakers would be forced to raise taxes or cut benefits for Florida’s most vulnerable populations.

Even more troubling than the escalating, out-of-control costs are the limited access to and poor quality of care under the antiquated, bureaucratic system. Under old Medicaid, only half of children received annual wellness check-ups and just 16 percent went to the dentist for preventive dental care. Only 4 percent of women received mammograms compared with 42 percent of women with no insurance at all. No incentives were provided for preventive care and disease management, and more and more people visited Florida emergency rooms for routine care.

Last month, the Florida Agency for Healthcare Administration recommended expanding the pilot project to 20 more counties. Expanding reform based on solid policy with a commitment to perpetual improvement will ensure Florida can continue to provide quality health care to more than 2 million poor, disabled and elderly Floridians.

Ultimately, success will be determined by improving the quality of care for Medicaid consumers and preserving manageable costs for Florida taxpayers. Successful reform depends on bold ideas, thoughtfully debated, responsibly implemented and objectively evaluated. Gov. Crist and the Legislature should carry forward with Florida’s landmark Medicaid reform.

Jeb Bush is former governor of Florida.