2011 Legislative Priorities

MEDICAID PRIVATIZATION

Protect Tax Payer Dollars (IGTs & CPEs)

• Tax payer dollars must be protected if the Medicaid programs they pay for are privatized to for-profit companies.
• Intergovernmental transfers (IGT) are self-imposed local tax dollars shared with the state to draw down federal Medicaid matching dollars.

• Certified public expenditures (CPE) are expenses that Medical Schools leverage to draw down teaching faculty physician funding.

Oppose Mandated Contracting & Rates

• Providers should be free to negotiate their level of participation and payment rates with health plans.

Support Fee for Service PSNs

• Cost-saving, fee for service shared savings provider service networks (PSN) will be necessary to ensure IGTs are protected and savings are returned to the state.

Support Service Areas v. “Regions”

• Service areas based on medical market referral patterns or local taxing district boundaries are recommended in lieu of the large rigid ‘regions’.

Support Risk-Adjusted Rates

• Continue and expand statewide risk-adjusted reimbursement rates for HMOs and PSNs.

• Risk-adjusted rates are applied in the current pilot counties because it is important to recognize the differences in health status of plan enrollees.

Support Payment Requirements For Out-of-Network Hospitals

• Require HMO’s to pay hospitals their full Medicaid rate for out-of-network care provided to their patients.

Foster Creation of PSNs

• Allow automatic assignment of up to 20,000 enrollees to fee-for-service PSNs.

MEDICAID LIABILITY

• Support liability protection for hospitals and physicians treating Medicaid recipients.

• Support provisions in HB 479, that ensure: hospitals are not liable for actions of independent contractor physicians; and equal access to medical witnesses in medical negligence actions.

MEDICAID FUNDING

Proposed cuts will strip almost $800 million from Safety Net Hospitals and negatively impact Floridians’ access to care.

Save Medically Needy Hospital Services

• 46,096 Floridians are expected to qualify as Medically Needy next year.

• Denial of hospital services for these eligibles will reduce hospital funding by $794 M and sacrifice $444 M in federal dollars.

Rethink Cuts in Hospital Payments

• The Legislature has imposed an 18% reduction in reimbursement rates over the last 6 years.

• The financial viability of safety net hospitals will be in jeopardy if this trend is not curtailed.

Accept Low Income Pool Council Recommendations for a Balanced Approach to Reductions

• Increased indigent care levels and loss of federal support necessitated cuts in the LIP program.

• The LIP Council recommended that all funding recipients absorb cuts in order to balance the program.

Hospital Reimbursement Formulas are a GOOD DEAL for Florida

• Hospitals and local communities SAVE the State over $1.1 Billion.
• State general revenue pays for ONLY 13.8% of Medicaid hospital inpatient reimbursement costs.

• The remaining 86.2% of hospital reimbursement is paid for by local tax payers in the form of intergovernmental transfers (IGTs) and the hospitals gross receipts tax.

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