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FPS TV, Feb. 23, 2011

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Get the latest FCAAP Legislative News update by watching FPS TV.

Senate's Medicaid Proposal the Riskiest Yet

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Greg Mellowe, Florida CHAIN

February 22, 2011- The Senate's 202-page Medicaid overhaul proposal, released last week, calls for building on and expanding key aspects of the fatally flawed Medicaid Reform experiment. It also borrows from the House's 2010 proposal to turn Medicaid entirely over to managed care plans. Although there are some improvements over the House proposal, the Senate plan adds many areas of serious concern.

One specific feature of the bill - a hard cap on total Medicaid spending - likely makes the proposal the biggest threat to Medicaid recipients ever seriously debated in the Legislature.

However, aside from the bill's threat to end the state-federal partnership if approval is denied, there is little reason to expect that federal approval is a possibility. Granting Florida such extreme flexibility to undermine Medicaid is likely even beyond the (federal) Centers for Medicare and Medicaid Services' ability to grant. Only Congress has the authority to change the fundamental nature of Medicaid.

Regardless, threatening to give up at least $12 billion a year in federal funding and placing countless vulnerable recipients and high-paying jobs at risk makes no sense.

The big-picture implications of the Senate bill, including the ways in which it differs from earlier Medicaid overhaul proposals, include:

1. Dramatic Expansion of Mandatory Managed Care

Currently, about two-thirds of Florida Medicaid recipients are enrolled either in MediPass (primary care case management) or in a managed care plan such as a Medicaid HMO. The rest are either exempt or excluded from managed care. In the five-county Medicaid Reform Pilot, however, MediPass is virtually eliminated. All recipients in the Pilot counties who are not exempt or excluded must enroll in a managed care plan.

Under the proposed Senate bill, a successor to the Medicaid Reform Pilot would expand statewide as of December 31, 2011. Most Medicaid recipients would be required to enroll in a Medicaid managed care plan. Recipients with developmental disabilities, current nursing home residents, those with catastrophic medical needs and children with extremely complex medical problems would be excluded.

The Senate proposal is especially problematic because, as in Medicaid Reform, HMOs will enroll the majority of recipients. Given their extensive track record of poor performance in Florida, forcing additional vulnerable groups in 62 additional counties (including rural areas) into Medicaid HMOs is a recipe for disaster.

The Senate bill also includes a number of features that would make the flawed Reform experiment even worse. These include requirements that most recipients pay $10 monthly premiums and that those with access to job-based coverage use Medicaid funds to enroll in that coverage instead.

2. Significant Flexibility, Limited Accountability and Transparency:

Medicaid Reform is more than just mandatory enrollment in managed care. For one, in Reform, each plan is given the flexibility to vary benefit levels and amounts. There is no longer a guaranteed benefit package that recipients can count on. Plans are required, however, to provide a benefit package equivalent in value to traditional Medicaid. The package must also include at least the same types of benefits available in traditional Medicaid.

The Senate proposal has many of the same problems as both Medicaid Reform and the 2010 House bill. The requirement placed on plans is only that benefits must be "sufficient" to meet the needs of "most" enrollees. The State is in charge of determining whether the plans' benefits are sufficient for what percentage of recipients. The different benefits (and different preferred drug lists) have made the plan choice process very confusing. Furthermore, patient encounter (i.e., service use) data still has yet to be used to assess the impact of this flexibility on access to care.

Like the 2010 House bill, the Senate bill would use a form of competitive bidding in which plans would negotiate contracts with plans behind closed doors. Instead of 6 regions, however, the Senate calls for 19 regions. This would intensify the confusion and concerns about accountability, as the same plan might be allowed to operate differently in different regions. A Florida Medicaid with a hundred different plans is not out of the question.

Although the Senate bill includes several improvements that would increase accountability above what was included in the 2010 House bill, it is still extremely vague in many areas. It also doesn't include safeguards to protect recipients if unforeseen difficulties push back the timeline, as has occurred repeatedly in the past. In addition, although the bill would hold plans accountable for actions that harm recipients, it does little to actually help the recipients who are harmed.

3. Hard Spending Cap & Continuously Adjustable Coverage

In addition to the above concerns, the Senate bill includes an additional feature that likely makes it a bigger threat than anything proposed previously. Specifically, it includes a provision intended to override everything that could protect Medicaid coverage. A hard cap (i.e., arbitrary limit) on total spending would trump everything else, regardless of the amount of harm done to vulnerable recipients as a result.

The Senate bill requires plans to start with the same goal of offering benefits at "sufficient" levels. Plans would at least be required to cover the "mandatory" types of services required by federal law. But it could be all downhill from there.

If the Legislature believes that adequate funding is available, plan payment rates could include money to cover so-called "optional" services. However, these services in fact include essential benefits such as prescription drugs or dentures. With the arbitrary hard cap squeezing tighter every session, however, "optional" benefits could quickly disappear. Even mandatory benefit levels could be eroded. Even recipients who under federal law must remain Medicaid-eligible could supposedly lose their eligibility.

Even worse, if at some point during the year, AHCA projects that Medicaid spending will exceed the amount in the State budget, AHCA must submit a cost-cutting plan for approval by a legislative budget committee (not the full Legislature). The reductions would occur regardless of the level of need or the fact that the shortfall is beyond the control of the recipients and providers who would be adversely affected.

AHCA would have to accomplish this cost-cutting in several different ways, in the following order: 1) eliminate "optional" benefits, 2) eliminate coverage for "optional" groups of recipients, 3) cut provider payment rates, and 4) reduce all other benefits for all other recipients. In the latter case, the Senate bill would allow even the most basic of Medicaid benefits to be cut. Once AHCA's cost-cutting plan is approved, then plans will be off the hook from providing services as well. Some recipients could lose benefits abruptly; others could lose coverage altogether.

Florida bill would ban doctors from asking about guns

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TALLAHASSEE — A Senate committee decided today it shouldn’t be a felony for doctors to ask patients about guns in their homes, but voted to make it illegal for them to reject new patients who refuse to say if they own firearms.The Senate Criminal Justice Committee postponed consideration of another gun bill that would let concealed-weapon permit holders carry guns openly – whether in hip holsters or slung over their shoulders.

A provision of that measure (SB 234) would repeal the gun ban on college campuses, which drew an emotional plea from Robert Cowie of Orange Park, father of a Florida State University student killed in a rifle accident at an off-campus fraternity party Jan. 9.

4 Sure, Get The 4th DTaP Tools

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Review the following items to help get children back in for their 4th DTaP vaccine. Attachments and URL link resources below

DOCTOR OF THE DAY PROGRAM 2011

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The 2011 Legislative Session begins on Tuesday, March 8, 2011, and the Florida Office of Legislative Services is looking for physicians to participate in the legislature's Doctor of the Day program. The legislature needs two physicians for each day of the legislative session, one for the House of Representatives and one for the Senate. If you are interested in serving as a Doctor of the Day, please contact Althea Houston with the Florida Office of Legislative Services at 850-488-6803. The 2011 Legislative Session is scheduled to adjourn Friday, May 6, 2011. See attachments below.

Clean Air News, Senators Bill Nelson and Marco Rubio Urged to Protect Public Health, Reject New Dirty Air Bills ? FPS President, Lisa Cosgrove, MD, quoted

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Clean Air News, Senators Bill Nelson and Marco Rubio Urged to Protect Public Health, Reject New Dirty Air Bills – FPS President, Lisa Cosgrove, MD, quoted

Firearms bill interview with CNN's Anderson Cooper and FPS EVP, Dr. Louis St. Petery

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Florida's Firearm Bill was televised on CNN's Anderson Cooper on January 18th. Dr. Louis St. Petery, FPS/FCAAP EVP, did an excellent job representing the pediatrian's position on the bill. Below are links to the coverage.

Introduction of Firearm Bill
Interview with Representative Frank Artiles
Interview with Dr. Louis St. Petery, FPS/FCAAP EVP

FPS Opposed to Firearms Bill / Press Release

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To Whom It May Concern:

This year, Florida Senators and Representatives will make a decision that will contaminate the physician-patient relationship. The Firearms Bill (HB 155/SB 432), in its current form, will prohibit physicians from inquiring whether there are guns in the home and prohibits the condition of treatment on such disclosure. The bill further provides penalties and maximum fines to physicians and health care providers if patients are asked such information.

As a Pediatrician, I am writing today to express my disapproval of the Firearms Bill. It is important for legislators and patients to understand that during an exam, several aspects of the home are discussed, including swimming pools, hazardous chemicals, smoke detectors, medications, and firearms. Answers to these questions help parents protect their child from multiple forms of harm.

A substantial amount of research found in the Journal of Developmental and Behavioral Pediatrics shows firearms in the home pose significant risks. Compelling evidence revealed that children who are in a home where a gun is located are very likely:

· to know where the gun is,

· to have played with it without their parents knowing,

· to have played with the gun in an aggressive manner , and are

· more likely to exhibit aggressive behavior towards other children in social play even in the absence of a gun.

Further research states that firearms contribute to otherwise avoidable suicide, homicide, and accidental death, which are among the leading causes of death among children and teenagers, as reported in the Annual Summary of Vital Statistics. Within the American Academy of Pediatrics Bright Future Guidelines, Pediatricians are explicitly recommended to ask about firearms and safe storage as standard routine for child health counseling.

To make education about firearm risk and safety illegal is dangerous and irresponsible to the highest degree. To make the proposed Firearms Bill into law would prevent me from doing one of the most important parts of my job: counseling and prevention. It is a Pediatrician’s mission to ensure the health and well-being of all children. I cannot help prevent devastating accidents if I do not ask about them.

K-12 SCHOLARSHIPS: YOUR CHILD,YOUR CHOICE

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Does your household income qualify your child for free or reduced lunch? If YES, then your child is likely to be eligible for either a $4,106 scholarship to a private school OR a $500 scholarship to cover transportation to a public school in a different county.

The scholarship is based on income, not academic performance. Last year, nearly 29,000 Florida children benefitted from this scholarship and were able to choose from one of roughly 1,200 private schools in Florida.

Step Up For Students is a nonprofit organization that administers the Florida Tax Credit Scholarship
for low-income students. The scholarship program was created by the Florida Legislature in 2001 and is funded by corporations that receive a dollar-for-dollar tax credit for their contributions.

Firearms bill filed with House and Senate

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January 13, 2011

Sen. Evers filed today SB 432, a Senate companion bill to the HB 155 regarding firearms. It is identical to the House Bill, stating a physician cannot inquire as to whether there are guns in the home, etc., nor condition treatment of patients on such disclosure. Click here to view the bill.

The FPS will send out a press release today regarding its view on the filed bills. The release was made possible through your responses on this listserve - Thank you for your involvement and support of the FPS.

Contact your local Representators and Senators to express why a pediatrician would need to ask a child if his/her parents have a firearm in the house. This type of information will support the dissolution of this bill far more than the view that this is an intrusion of parent privacy.