Florida Statewide Medicaid Managed Care Program – Webinar 1/21/14

The Agency for Health Care Administration invites you to participate as an attendee in the following online training session:

Topic: SMMC: Developmental Disabilities Webinar
Host: The Agency for Health Care Administration
Date: Tuesday, January 21, 2014
Time: 11:00 am, Eastern Standard Time (New York, GMT-05:00)
Session number: 643 551 021
Session password: This session does not require a password.

To join the training session

1. Go to https://suncom.webex.com/suncom/k2/j.php?ED=259209702&UID=1732291422&HMAC=7e63c53a351f9355a3cc5729dd8669f01089473c&RT=MiMxMQ%3D%3D
2. Enter your name and email address.
3. Enter the session password: This session does not require a password.
4. Click “Join Now”.
5. Follow the instructions that appear on your screen.

To view in other time zones or languages, please click the link

More Cuts to Rates in Florida’s APD Budget

APD Continues Cost Containment Efforts

Tallahassee — On April 1, Agency for Persons with Disabilities (APD) will reduce the rates it pays for therapy assessments and all nursing services to the standard rate paid by the Medicaid State Plan. Currently, the APD Home and Community-Based Services Medicaid waiver pays higher rates for most of these services.

This rate change is the latest cost containment effort by APD to work toward bringing waiver expenses closer to the agency’s Legislative appropriation for the waiver.

The Legislature approved $810 million for APD’s Home and Community-Based Services Medicaid waiver for the 2011-12 state fiscal year that began on July 1. APD customers received $930 million worth of services last year.

While the agency is working to reduce Medicaid waiver expenditures, it is also looking for opportunities to increase waiver flexibility and equity for customers with the new iBudget Florida waiver. More than 3,000 APD customers in North Florida have transitioned to the new iBudget waiver which allows families to shift funding around to meet their current priorities.

APD annually serves more than 50,000 Floridians with developmental disabilities of autism, cerebral palsy, Down syndrome, intellectual disabilities, spina bifida, and Prader-Willi syndrome. The agency’s Medicaid waiver helps to support about 30,000 individuals with developmental disabilities so they may live and participate in their local communities. Those 30,000 people will all be transitioned to the new iBudget Florida waiver by July 2013.

For more information on iBudget, visit the website iBudgetFlorida.org.

For more information on the agency, call 1-866-APD-CARES or visit APDcares.org.


CMS Medicaid Rate-Setting

States Worry Upcoming CMS Medicaid Rate-Setting Reg Could Bust Budgets

Posted: March 18, 2011

States are worried that either the Supreme Court or CMS could allow providers to challenge Medicaid rates, which they say would likely lead to higher rates that, when combined with maintenance of effort requirements, could bust budgets and lead to states cutting long-term care services. Even if legal battle goes well for states, CMS separately is working on a rule, and that rule could give providers a route for challenging state rate-setting, a state source says, though details of the upcoming rule remain unclear.

One state legislative source said there appears to be an interest among Democrats in giving CMS more of a role in state rate-setting because the House considered such a measure during the health-overhaul debate, but that measure got little attention and did not make it into the Affordable Care Act.

Providers used to be allowed to challenge the Medicaid rates that states set under the “Boren Amendment.” Boren forced states to reflexively increase reimbursements for hospitals and nursing homes because the cost of doing so was less than the cost of fighting a barrage of well-financed lawsuits, said Matt Salo, executive director of the National Association of Medicaid Directors. That’s why Congress repealed the law in the late 1990s. But if states lose the legal battle, it would bring back the days of Boren and force states to increase reimbursement across the board, he suggested.

States are facing a collective $175 billion budget shortfall over the next biennium and reimbursement rates are one of the few ways states can control costs. If states’ hands are tied on reimbursement rates, and they are not allowed to cut beneficiaries from the rolls because of ACA’s maintenance-of-effort requirements, that would put the bulk of Medicaid spending off limits, and Medicaid represents a huge chunk of state spending, Salo said. The only thing left for states at that point would be draconian measures, such as eliminating many long term care services that are not mandatory.

The Supreme Court recently agreed to hear arguments in Independent Living Center of Southern California v. Maxwell-Jolly. Specifically, the court will consider whether federal courts have the right to review claims against state Medicaid programs that states have violated federal law by paying rates that are so low that providers refuse to treat Medicaid beneficiaries.

But another state source says the lawsuit may not matter if CMS decides to allow providers to challenge rates in a regulation it is writing.Sen. Charles Grassley (R-IA) brought up that regulation at a recent Senate Finance Committee hearing and asked that HHS brief his staff about the regulation because so little is known about it. “It’s not clear what the guidance might entail, such as whether it would lead to different reimbursement rates,” a Grassley release states.

“We thought we put a stake in that heart,” the state source said. “Maybe not so much. That vampire is not dead.”

The source said it is not clear that CMS is going to go that far. However, it makes states uneasy that House Democrats included a measure in a version of health reform legislation that would have let CMS issue guidance on rate setting, and it would have given CMS a fair amount of authority to determine that rates are not sufficient. Typically, CMS has not micromanaged state rate-setting, sources said.

Another state sources say some state representatives have spoken to CMS about the regulation, which Grassley said is in response to the Supreme Court. One state source says the regulation is aimed at telling states how they should determine that rates do not hurt access. States do not want to be required to show in advance that rates will not hurt access; they prefer having a period of time to determine whether access is hurt by monitoring doctor to patient ratios, call center complaints and beneficiary appeals, sources said.

A provider source said states also do not want the cost of care to be a factor in determining whether access is sufficient. The Boren Amendment required that Medicaid rates cover at least the cost of delivering care, and without that requirement, it is difficult to determine whether rates are sufficient, the source said.

A CMS spokesperson said the proposed rule will call for standardizing state reporting and data collection on payment rates and access to care, and it will include guidance on compliance with the access requirement that providers have been using as grounds to challenge Medicaid reimbursement cuts.

Florida Developmental Disabilities Day

Next week many advocates, family members, and professionals plan to come to Tallahassee to support DD Awareness Day.  The Arc of Florida and the Florida Developmental Disabilities Council have planned an educational day filed with exhibits, a press conference, and luncheon.  A schedule of activities is below.

Florida ARF and a number of members will have booths on the 2nd Floor of the Capitol in the Rotunda.  Please stop by and see them or use this as your meeting point.

 Florida ARF

DD Days at the Capitol

In collaboration with Arc of Florida and the Florida DD Council, Florida ARF encourages member agencies and the individuals they serve to attend DD Days on March 23.

What: DD Days at the Capitol

When: March 23, 2011

10:00 a.m. – 3:30 p.m.

Where: The Florida Capitol Building in Tallahassee, FL

How: Meet at the Florida ARF headquarters office at 10:00 a.m. to park vehicles and catch the Arc of Florida van to the Capitol.

Schedule: 10:00 a.m. – 11:30 a.m.

  • Visit booths in the Rotunda
  • See legislators (appointments recommended) and/or aides.
  • Tour the Capitol

11:30 a.m. – 1:30 p.m.

  • Lunch in the courtyard between Old and New Capitol building

(pizza and drinks provided – reservations required)

  • Entertainment by Pyramid Sunshine Band
  • Speeches from Governor’s Office and House &Senate Leadership

1:30 p.m. – 3:30 p.m.

  • More legislative visits
  • Meet at bus pick up site at back of the Capitol
  • Return to Florida ARF parking lot
  • Depart by 3:30 p.m.

The Governor and House and Senate leadership have been invited so there may be an opportunity for brief interaction.  To identify your legislators, go to www.floridaarf.org/grassroots and view your agency specific legislative profile.

Questions: Call 850-877-4816.  Ask for Suzanne at Extension #123 or Courtney at Extension #114.

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