By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-967319.mp3
Tallahassee, FL –
The Florida House and Senate have reached a long-awaited deal to revamp the state's Medicaid program. The two chambers crafted separate proposals on how to shift about 2.9-million Floridians into managed care networks. But differences between the bills almost derailed the plan. But as Lynn Hatter reports, House and Senate negotiators have hammered out a compromise.
Republican Senator Joe Negron has been working on the Senate's version of a Medicaid plan to reduce the costs of the program estimated at 22-billion dollars this year and growing. So naturally Negron starts off his explanation of the compromise plan by talking about how much money the Medicaid managed care shift will save.
"Number one, for year one when we make this transition, that we expect a five-percent guaranteed savings. So that means that in year one, we'll save at least 1.1-billion dollars in our Medicaid program. We also have language in the bill that says the Agency for Healthcare administration can't enter into agreements that in the aggregate, exceed the general appropriations act, so the legislature will determine how much we will spend on Medicaid."
Under a compromise proposal the state would be divided into 11 regions where managed care companies would compete for contracts to operate. The House wanted only eight regions, while the Senate called for 19. According to the compromise, seniors would enter new managed care plans in October of 2013 and be guaranteed certain services if they are in nursing homes.
"There will be a Medicaid rate for nursing homes, a direct pass through without stopping at the managed care entity. We'll save money by getting more people into home and community based care programs. And then another item I fought hard for was, if you're in a nursing home, its more than a medical situation. And if a nursing home accepts seniors, they should pay for dental, vision and hearing. It shouldn't be left to residents, and we require them to include that on their rate."
The bill caps non-economic damages like pain and suffering, against doctors and providers who treat Medicaid patients at 200-thousand. But there's no cap for treatment-related costs. The Liability caps are something that have been a contentious issue with many groups, like the Florida AARP.
Supporters of the liability caps say it's needed to get more doctors participating in Medicaid. Right now there's a shortage of physicians who accept Medicaid patients because of low reimbursement rates and the threat of lawsuits. Under the compromise, primary care doctors could see higher reimbursement rates.
Developmentally disabled Floridians are except from the managed care networks and will stay with the current, fee-for-service model. But not included in the plan is the medical-loss ratio. It's a figure used to determine what percentage of dollars taken in that has to be spend on medical care. Senator Eleanor Sobel.
"We got a letter from the federal government saying they tend to like the medical loss ratio, but we've removed that. Which gives us an indication that the federal government might be interested in approving it if we had that if we're serious about reform, why aren't we including that?"
In order for the Medicaid managed care plan to go through, it needs federal approval, and a letter sent by the federal Center for Medicaid and Medicaid services suggested if there was no medical loss ratio in place, Florida could kiss such a waiver goodbye. Democrat Jeremy Ring picked up on Sobel's point asking, what happens if Florida doesn't the waiver?
"So, what do we do if the federal government were to reject this plan?"
Negron: "We'll continue to negotiate with CMS and work out language, but I don't think we should allow Washington to commandeer our budget and I think they'll work with us because they have the same economic pressures that we have."
The short answer: There is no backup plan. The compromise cleared the Senate and now heads to the House. It's set for a final vote on the last day of the 2011 legislative session.