FAHCS Puts a New Face on HME as Florida Moves on Medicaid Plan

TALLAHASSEE, Fla. — Despite the efforts of providers
throughout the state, the Florida House of Representatives approved
a plan April 19 that would move the state’s Medicaid patients into
health maintenance organizations — all 2.7 million of
them.

According to some legislators, the plan would control costs,
reduce fraud and abuse and provide better care for participants.
According to providers, it could cause
numbers of HME businesses to close and thwart beneficiary
choice of care.

Under the plan, fee-for-service care would be phased out.
Instead, the state would be divided into six regions in which
managed care companies would bid for the right to provide Medicaid
services. The plans would be rebid every five years.

“We started a phone call campaign, we lobbied on behalf of the
industry, we educated the highest-ranking leaders and used personal
relationships to push for acknowledgment of our issues and a
commitment to address them (some of our members even hosted rallies
in front of senior leadership’s district offices),” said Sean
Schwinghammer, executive director of the Florida Alliance of Home
Care Services.

While the effort was unsuccessful in preventing the bill’s
passage, “we were heard,” Schwinghammer said.

“We do not have all that we want yet — inclusion of all
providers within the new process — but we did secure language
that was approved … to require HMOs to contract with multiple
and diverse home medical equipment suppliers to meet the problems
we identified from the monopoly creation they were fostering,”
Schwinghammer said.

“Also we were able to add language to delay implementation of
the program from this summer to 2012 in Miami Dade County and 2015
statewide.”

Schwinghammer says he considers the effort a victory of sorts in
that less than a week before the bill passed “we were told by
senior staffers that our entire industry is fraudulent and they did
not want to work with us … [but] we had some of our language
on the bill that passed.”

In March, the state’s Senate passed a bill that would expand a
pilot Medicaid managed care project to 19 of its 67 counties. A
committee from both legislative chambers is now working on a
compromise bill to reconcile the two plans.

“They may have differences, but the overarching goals are the
same, to move Medicaid patients of all kinds into managed care,”
Schwinghammer said.

With only a few days left in the legislative session and
Florida’s current Medicaid program expected to consume nearly 28.3
percent of the total state budget, he noted there is a tough job
left in appealing to members of the Senate this week not to move to
the House plan.

“There is more to do, to appeal to the Senate, to present to the
conference committee, to appeal to the governor, but, at least
there is now a point of conversation, something we can put more
teeth into instead of being rolled over.”

To “redefine the argument” and help fight the Medicaid proposal,
FAHCS is appealing to providers to “put a new face on HME.” The
association wants every provider in Florida to take a picture of
its employees in front of its offices. “If you have more than one
facility, please take a photo in front of each. The more the
better,” a FAHCS notice said, making sure the company name is
visible.

FAHCS also asked that the photo include a sign with the number
of patients the company cares for. The photos will be compiled into
a booklet to be delivered to each of the state’s legislators to
“debunk the myth that most companies are not real companies, only
post office boxes that bill illegally,” the association appeal
said.

The photos and information including company name, service area,
number of years in business, types of services provided and patient
population should be sent to [email protected].