STATE CAPITAL BRIEFS: WEDNESDAY, MAY 13, 2015
THE NEWS SERVICE OF FLORIDA

©2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

STATE ENDS LAWSUIT SEEKING ACCESS TO VA HOSPITALS
The Florida Agency for Health Care Administration on Wednesday dismissed a nearly year-old lawsuit aimed at giving state inspectors access to federal Veterans Affairs medical centers and documents. AHCA and two individual plaintiffs filed a notice in federal court in Tampa that they were dismissing the case, and U.S. District Judge Charlene Edwards Honeywell formally approved the dismissal. The federal government fought the lawsuit, arguing last year that the U.S. Constitution’s “Supremacy Clause,” bars states from regulating federal activities without consent. Gov. Rick Scott’s office said the dismissal came after Veterans Affairs Secretary Robert McDonald fulfilled state requests for access to information about VA medical facilities, which became embroiled in controversy last year because of reports of substandard care and conditions. The governor’s office released correspondence indicating Scott and McDonald spoke on the telephone March 18. McDonald, in a May 4 follow-up letter, expressed willingness to provide reports about inspections of the facilities and information about remedial actions by the VA. In a letter Wednesday, Scott said he appreciated McDonald’s willingness to provide audit reports to AHCA. “We have said for some time that Veterans Affairs was not taking our requests for information seriously, and your commitment demonstrates a fundamental shift from how the federal department previously operated,” Scott wrote. “It is imperative, however, that the VA follow through on its commitments; no doubt greater transparency and accountability will benefit our veterans.”

BROWN WANTS FEDS TO TALK TO JACKSONVILLE
Jacksonville Mayor Alvin Brown is asking U.S. Health and Human Services Secretary Sylvia Burwell to negotiate directly with his city if a state showdown with the federal government endangers funding for the Low Income Pool, or LIP, program. In a letter dated Wednesday, Brown emphasized the importance of LIP to UF Health Jacksonville, a major component of the area’s health-care system. LIP provides money to hospitals and other medical providers that care for large numbers of low-income patients. “Jacksonville and other communities with safety-net hospitals must not be held hostage by the actions or inactions of decision-makers in Tallahassee. … If our state government cannot or will not act, the city of Jacksonville and other local governments should have the opportunity to bypass Tallahassee and work directly with the federal government to find innovative LIP and Medicaid solutions,” wrote Brown, who is running for re-election in Tuesday’s municipal elections. The future of the $2.2 billion LIP program has become ensnared in a debate over whether to use Medicaid expansion funds to help low-income Floridians purchase private insurance. Meanwhile, Gov. Rick Scott, who opposes any plan drawing on Medicaid expansion money, released a letter to Burwell dated Tuesday requesting information for a commission he’s set up to consider health-care funding in the state. That commission has scheduled its first meeting for May 20 in Tallahassee.

ASKEW, MATHIS, DAVIS ADDED TO CIVIL RIGHTS HALL
Former Gov. Reubin Askew and civil-rights leaders Sallye B. Mathis and Edward Daniel Davis were inducted Wednesday into the Florida Civil Rights Hall of Fame during a ceremony at the Capitol. Askew, who died last year, was elected governor in 1970 and served two terms. He was named to the hall of fame in part because of his support for desegregation and his appointments of top black officials, including the first black justice on the Florida Supreme Court. Mathis, who died in 1982, was a longtime teacher in the Duval County school system and a civil-rights leader who was elected to the Jacksonville City Council. Davis, who died in 1989, served as president of the Florida State Conference of the NAACP and was an educator who fought for equal pay for black teachers. Askew’s widow, Donna Lou, accepted the honor on the late governor’s behalf. “Reubin would be so pleased to be with these two wonderful people, Ms. Mathis and Mr. Davis. What a group to be together. Maybe they are having a little meeting today,” she said, drawing laughter. Gov. Rick Scott announced the hall-of-fame selections in March.

–END–
5/13/2015

© 2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

Independent and Indispensable

http://www.newsserviceflorida.com

This content is available at:
http://www.newsserviceflorida.com/nsf/raw_asset.html?className=stories&itemName=story&selector=2015782

White House Moves to Fix 2 Key Consumer Complaints About Health Care Law

WASHINGTON — The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.

Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.

Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.

The Obama administration recently adopted stricter standards stating that each insurer in the federal marketplace “must publish an up-to-date, accurate and complete provider directory, including information on which providers are accepting new patients, the provider’s location, contact information, specialty, medical group and any institutional affiliations.”

In addition, Mr. Counihan said, the administration will require insurers to provide physician information in a format that software developers can use to create tools to help consumers find health plans in which their doctors participate. Consumer advocates like Robert M. Krughoff, the president of the Center for the Study of Services, also known as Consumers’ Checkbook, said such tools could be a boon to consumers.

The new standards significantly strengthen an earlier rule, which required insurers to publish directories online and to make paper copies available on request. In the federal exchange, violations are subject to civil penalties of up to $100 a day for each person adversely affected.

Federal officials said that inaccurate provider directories could be a sign of larger problems. If doctors listed in a directory are not available or are not taking new patients, consumers may not have access to covered services, and the insurers may not meet federal standards for “network adequacy,” the officials said. Consumers must often pay extra when they use doctors outside the network of their health plan, so an inaccurate directory could also lead to higher costs for patients.

Moreover, doctors said that they too need accurate directories so they can refer patients to physicians in the network when specialized treatment is required.

“The impact of inaccurate provider directories on consumers can be devastating, especially on those consumers who need to carefully examine networks for specific subspecialists, cancer centers or children’s hospitals,” the American Medical Association told state insurance officials in a recent letter endorsed by dozens of health care provider and patient groups.

But insurers say that the problems might not be easy to fix, and that doctors are partly to blame for the directory errors. Insurers “are unable to guarantee the accuracy of the provider’s status” in a directory because doctors often “stop accepting particular health plans’ members off and on throughout the year and fail to notify the plan in a timely manner,” America’s Health Insurance Plans, the chief lobby for the industry, said in a letter to the Obama administration.

In its online doctor directory, Blue Cross and Blue Shield of Texas says that it makes every effort to provide correct information, but that it “cannot be responsible for omissions or errors in the provider details.” Aetna says that data in its directory is “subject to change at any time.” UnitedHealth tells Medicare beneficiaries, “A doctor listed in the directory when you enroll in a plan may not be available when your benefits become effective.”

The problems that consumers face with unexpected costs may result, in part, from the way plans are listed on HealthCare.gov, the website for the federal marketplace. More than 8.5 million people are in private health plans selected through the site, and the plans are listed in order of their premiums, from lowest to highest.

This encourages consumers to focus on premiums rather than total costs, said Mr. Krughoff, the Consumers’ Checkbook president, and they often spend hundreds or thousands of dollars more than they need to.

Mr. Krughoff’s group has been publishing a guide to health plans for federal employees for more than 30 years, and a version of its online toolfor comparing health plans is available on the website of the federal marketplace in Illinois. “It’s been a great tool,” said Jose M. Muñoz, a spokesman for Get Covered Illinois, the state agency that promotes enrollment.

The tool can perform searches tailored to a person’s needs and priorities. It asks consumers to describe their health status, offering five levels from excellent to poor, and to list “expected medical procedures” like childbirth,knee replacement or prostate removal. It also provides an estimate of total yearly costs for the user.

Federal officials said that they might link HealthCare.gov to an out-of-pocket cost calculator later this year, and that they hoped to make such comparisons a standard part of the shopping experience at the site in later years.

“We know that we have work to do to make it easier for consumers to find plans that meet their needs,” said Lori Lodes, a spokeswoman at the Centers for Medicare and Medicaid Services, which runs the federal marketplace serving more than 30 states.

A few state-run exchanges are developing similar tools. Peter Nichol, the information technology director for the state insurance exchange in Connecticut, said it would add a “cost calculator” to its website this summer.

The Obama administration is also taking steps to increase the accuracy of doctor directories in Medicare. About 30 percent of the 55 million beneficiaries are in private Medicare Advantage plans that typically use networks of doctors to care for patients.

The Medicare agency said it had received complaints about insurance company directories that included doctors who “have retired from practice, have moved locations or are deceased.” New federal rules will require insurers to update their Medicare directories each month, “with specific notations to highlight those providers who are closed or not accepting new patients.”

A version of this article appears in print on May 9, 2015, on page A13 of the New York edition with the headline: White House Moves to Fix 2 Key Consumer Complaints About Health Care Law. Order Reprints| Today’s Paper|Subscribe

Source: NY Times

CONGRESSIONAL HEARING PLANNED ON LIP SHOWDOWN

By BRANDON LARRABEE
THE NEWS SERVICE OF FLORIDA

©2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

THE CAPITAL, TALLAHASSEE, May 12, 2015……….A congressional committee will hold a hearing on Gov. Rick Scott’s showdown with the federal government over health-care funding, but that meeting could come too late to help close a potential $2.2 billion hole in the state budget.

Scott announced Tuesday that U.S. Rep. Fred Upton, R-Mich., will have the House Energy & Commerce Committee look into the governor’s allegations that the U.S. Department of Health and Human Services is trying to illegally coerce the state into accepting Medicaid expansion.

The agency has said that Medicaid expansion will be a factor as it weighs a proposed revision to the Low Income Pool, or LIP, program, but has not explicitly said that the state must expand coverage to receive any funding. The $2.2 billion LIP program, which mostly sends money to hospitals and other medical providers that care for large numbers of low-income patients, is set to expire June 30 unless state and federal officials reach an agreement.

“The committee’s hearing will bring much-needed attention to the Obama administration’s disappointing political power play at the expense of the health care of low-income families in our state,” Scott said in a statement issued by his office.

The governor has filed a lawsuit against the Obama administration to attempt to block federal officials from factoring whether the state has expanded Medicaid into its decision on LIP. But federal officials say that they don’t want LIP to pay for the medical expenses of Floridians who could otherwise be covered by Medicaid.

The agency said last week that, at first blush, the state’s new LIP application “falls short of key principles” that federal officials will consider when weighing the program’s future, but a spokesman said Tuesday the agency “is continuing to engage” with the state.

A spokeswoman for Upton’s committee confirmed in an email that a hearing was being planned, but didn’t indicate whether it would come before June 30, the deadline for the Legislature and Scott to agree to a budget before state government could shut down.

“The committee, in its continued commitment to protect the Medicaid program so it is able to deliver on its core function of providing a lifeline for the most vulnerable, is keeping a close eye on the situation in Florida,” the spokeswoman said. “Chairman Upton spoke with Governor Scott today and the committee plans to hold a hearing in the coming months.”

Scott spent Tuesday in Washington, D.C., meeting with 14 members of the state’s congressional delegation as well as Upton and Senate Majority Leader Mitch McConnell, R-Ky.

Funding for LIP is part of a complex health-care logjam that has left legislative leaders unable to reach agreement on a spending plan for the budget year that begins July 1. Hoping to encourage federal officials to approve the state’s LIP proposal, the state Senate offered a $2.8 billion initiative that would use Medicaid expansion funding to help low-income Floridians purchase private insurance.

But Scott and the state House adamantly oppose the expansion alternative, which would be funded through the Affordable Care Act, commonly known as Obamacare.

–END–
5/12/2015

© 2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

Independent and Indispensable

http://www.newsserviceflorida.com

SCOTT CALLS FOR HOSPITALS TO SHARE PROFITS

By BRANDON LARRABEE
THE NEWS SERVICE OF FLORIDA

©2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

THE CAPITAL, TALLAHASSEE, May 8, 2015………. Gov. Rick Scott said Friday that, like Major League Baseball teams, hospitals should share profits if the federal government refuses to authorize $2.2 billion in health-care spending.

In a letter to the president of the Florida Hospital Association, Scott proposed that hospitals agree to share profits if the U.S. Health and Human Services Department rejects the state’s application to extend the Low Income Pool, or LIP, program. The program, which mostly sends money to hospitals and other medical providers that care for large numbers of low-income patients, is set to expire June 30 unless state and federal officials reach an agreement.

“After my meeting with HHS, and their subsequent press release criticizing our pending LIP application, I now believe it is more important than ever for us to begin preparing a state budget without any LIP funds from the federal government,” Scott wrote to FHA President Bruce Rueben.

Federal officials have not officially decided whether to renew the LIP program, but said Wednesday that, at first blush, “the proposal currently posted for public comment in Florida falls short of the key principles HHS will use in considering proposals regarding uncompensated care pool programs, and the size of the proposed LIP appears larger than what matches the principles.”

Scott, a former hospital CEO, drew on an unlikely metaphor while proposing that hospitals could share what he called “$3.7 billion in record profits.”

“Your assistance in suggesting fair profit sharing to replace federal LIP funds at those institutions that rely on them most, like Shands Jacksonville, will be critical to keeping them up and running,” he wrote. “This would be similar to how large market baseball teams share revenues with small market baseball teams.”

Scott said he wanted the hospitals to submit three models by May 22, so that his Commission on Healthcare and Hospital Funding could consider them on May 26.

Lawmakers are set to begin a special session to resolve the state budget plan on June 1.

Funding for LIP is part of a complex health-care logjam that has left legislative leaders unable to reach an agreement on a spending plan for the budget year that begins July 1. Hoping to encourage federal officials to approve the state’s LIP proposal, the Senate proposed a $2.8 billion initiative that would use Medicaid expansion funding to help low-income Floridians purchase private insurance.

But Scott and the House have fiercely opposed the expansion alternative, and the governor has sued in an effort to prevent federal officials from linking the LIP decision to Medicaid expansion. In his letter Friday, Scott said federal officials had ruled out a part of the Senate plan that would require some recipients to work.

Meanwhile, Democrats pounced on an Associated Press story saying that Scott’s support for Medicaid expansion in 2013, which he attributed in part to his mother’s death, was a “ruse” to get the federal government to approve a waiver for the state’s existing Medicaid program. Scott mentioned the waiver when asked Thursday why he backed expansion, which was rejected at the time by the Legislature.

“The lengths to which Rick Scott will go to mislead the public are disgusting,” Florida Democratic Party Chairwoman Allison Tant said. “Shame is not a strong enough word.”

But Scott’s office said the AP misinterpreted his remarks.

“The Governor was asked by an AP reporter whether or not his support for Medicaid expansion in 2013 was a ‘lie.’ Governor Scott answered the question by discussing that he came out in support of Medicaid expansion, only if it was fully federally funded, at the same time the federal government granted Florida a waiver to let the state reform its Medicaid system. Unfortunately, the AP editorialized the Governor’s statement,” the governor’s office said in a statement issued Friday.

–END–
5/8/2015

© 2015 The News Service of Florida. All rights reserved. Posting or forwarding this material without permission is prohibited. You can view the Terms of Use on our website.

Independent and Indispensable

http://www.newsserviceflorida.com