Florida Changes May Cost Counties

Gov. Rick Scott signs Medicaid billing changes; may cost counties $326 million

By Tia Mitchell
Miami Herald/Times Tallahassee Bureau

Against the wishes of counties and tea party leaders, Gov. Rick Scott signed a controversial bill into law Thursday that will change the way counties are billed for Medicaid costs and could set up a legal showdown.

If nothing changes, counties could be forced to pay the state an additional $325.5 million in the coming years in disputed Medicaid bills.

“Nobody really knows what this is going to mean to our budget,” said Gretchen Harkins, Broward County director of intergovernmental affairs. The Florida Association of Counties has convened a task force to recommend future steps, such as seeking an injunction or filing a lawsuit.

Scott took the unusual step of submitting a letter to the Secretary of State’s office explaining why he signed the bill, HB 5301. Scott acknowledged the counties’ concerns and vowed to work with them to resolve years of disagreements with the Agency for Health Care Administration on how much they owe for Medicaid.

“To that end, I have pledged to the counties that AHCA and my staff will work diligently with them to certify that any billings for which counties are charged are accurate and valid,” Scott wrote.

Representatives from AHCA will travel to each county to review the disputed amounts and discuss other issues with the billing process, the letter said. Counties say the system has been flawed for years, resulting in incorrect and duplicative statements.

Under the plan, counties can dispute the unpaid Medicaid bills in administrative hearings but are on the hook for paying back 100 percent of the backlog if they lose. Or, counties can agree up-front to pay back 85 percent of the disputed bills.

The state will withhold sales tax revenue sharing dollars from counties to cover past, as well as any future, Medicaid costs.

All but seven of the state’s 67 counties sent Scott letters urging him to veto the bill. They accused the state of tinkering with the Medicaid billing system in an effort to shift additional costs to local governments.

Florida Association of Counties President Doug Smith said the bill “represents the worst kind of body blow to taxpayers.”

“Rather than correcting Tallahassee’s error-ridden Medicaid billing system, HB 5301 codifies it and leaves local taxpayers with the bill,” said Smith, a Martin County commissioner, via email.

The Florida Tea Party Network, a coalition of about 80 groups, joined the counties in lobbying against the proposal. Henry Kelley of Fort Walton Beach, the Tea Party Network’s legislative liaison, said he was disappointed in the governor’s actions.

“From a tea party perspective (and) the issue of limited government, now you’re tying the hands of the counties,” he said. “But you’re also signing into law something where you know there’s a billing problem.”

Although the Medicaid billing issue drew the most attention, HB 5301 affected other areas of the state’s Medicaid program, which provides health care services to 3.2 million poor and disabled Floridians.

It cuts costs by limiting nonpregnant adults to no more than six emergency room visits a year and allows state employees to enroll their children in the KidCare health insurance program.

Scott also signed nine claims bills into law Thursday, compensating victims of government wrongdoing nearly $40 million.

Scott signed a $10.7 million claim for the family of Eric Brody, who was permanently injured 14 years ago when a speeding Broward County Sheriff’s deputy plowed into his car.

Most jury awards against government entities or employees — school bus drivers, hospital workers, police officers — have to be approved by the Legislature if they are in excess of $200,000.

The governor used his first veto this year to strike down a bill that would have given $1.4 million to a man who lost a leg in an accident with a Sumter County school bus, indicating that the amount was too high.

Herald/Times staff writer Toluse Olorunnipa contributed to this report.

Read more here: http://www.miamiherald.com/2012/03/29/v-print/2721744/gov-rick-scott-signs-medicaid.html#storylink=cpy

Hospitals Worry About Mandate Loss


Hospitals fear loss of insurance payments if coverage mandate is struck down

Leaders say situation would deteriorate further if Obama administration pushes ahead with reimbursement cuts even if provision is eliminated

By Peter Frost, Chicago Tribune reporter

11:21 AM CDT, March 29, 2012



Like their counterparts across the country, Chicago hospitals have invested millions of dollars preparing for the implementation of the federal health care law, potentially for benefits they may never reap if the U.S. Supreme Court strikes down key parts of the law.

The court, which wrapped up three days of hearings Wednesday, is considering whether a requirement that most Americans carry health insurance or pay a penalty violates the Constitution.

In their final day of hearings, justices indicated they may throw out other parts of President Barack Obama’s health care law if they strike down the mandate, which is expected to expand insurance to about 30 million Americans.

“This is one of those things where you have to be careful what you wish for,” said Dr. Lee B. Sacks, executive vice president and chief medical officer for Advocate Health Care, the region’s largest health group. “The consequences of striking down the law may be far worse than dealing with the changes (the law required) over a several-year period.”

The American Hospital Association argued in a brief to the court that the bill could hurt hospitals’ finances if the individual mandate is the only portion of the law to be struck down or altered.

Hospitals expected a wave of newly insured patients to offset cuts to government reimbursement for programs like Medicare and Medicaid called for under the law. They fear they may be squeezed by declining payments without the benefit of an influx of new patients.

If the court finds the law unconstitutional, the government may press ahead on plans to cut reimbursements in a effort to rein in spending, an initiative Sacks says “won’t serve patients and won’t lead to better access and more equitable care.”

“In the short term, there will be a significant number of uninsured (patients) that we won’t get compensated for, and that becomes a barrier to access and forces us to shift costs to other payers,” Sacks said.

Paula M. Noble, chief financial officer at Children’s Memorial Hospital in Lincoln Park, said the hospital is concerned that if the court strikes the law in its entirety, some of the hospital’s patients would lose benefits that have already been implemented. Specifically, she fears that they would lose their private insurance coverage because of pre-existing conditions or if they exceed lifetime caps on coverage.

Instead, she said, those patients would be forced to rely on Medicaid, a chronically underfunded program that is facing “devastating cuts.”

“This would create further challenges for Children’s Memorial, other hospitals and the state of Illinois,” she said.

At the same time, however, hospital executives argued that regardless of whether the law stays intact, a series of meaningful and transformative changes that it spurred in the industry will continue.

Combined with the economic recession, the 2010 law sharpened hospitals’ focus on driving efficiency by coordinating patient care and automating health care records, two initiatives that allowed hospitals to become more clinically integrated, said Mark Newton, president and chief executive of Swedish Covenant Hospital.

Those improvements help hospitals offer better care to patients and better value to payers, he said.

“Regardless if the law stands, there are certain changes occurring where I think some good things will result,” Newton said. “Even if (the court) throws the whole thing out, there are some residual positives that came out of this, and, if nothing else, it gives Congress a chance to go back and really look at what’s working and what’s not.”


White House Counts on Mandate

UPDATE 1-White House: no contingency plan if healthcare law rejected

Wed, Mar 28 2012

* Top officials have cited options in the past

* Analysts see vulnerabilities for Obama’s base

* Any action unlikely until after November vote (Adds quotes, details and background)

By David Morgan and Jeff Mason

WASHINGTON, March 28 (Reuters) – The White House said on Wednesday that it was not working on contingency plans for President Barack Obama’s signature healthcare law, in the event that the Supreme Court struck down all or part of the sweeping reforms.

After three days of landmark Supreme Court hearings that raised doubts about the law’s fate, White House spokesman Josh Earnest said the administration remains confident that the 2010 reform measure would be upheld when justices issue their ruling toward the end of June.

“There is no contingency plan that’s in place. We’re focused on implementing the law,” Earnest told reporters. “If there’s a reason or a need for us to consider some contingencies down the line, then we’ll do it then.”

A negative ruling from the court would be seen as a major blow to Obama in the middle of an election year, when Republicans are demanding the repeal of the Patient Protection and Affordable Care Act.

Obama’s re-election prospects already face substantial challenges. A new Reuters/Ipsos poll shows that two-thirds of Americans, including a majority of Democrats, disapprove of his performance on another big issue: high gas prices.

The healthcare law and its unpopular individual mandate, which requires most Americans to have health coverage beginning in 2014, came under sharp scrutiny from the high court’s five conservative justices.

Doubts about its future deepened with tough courtroom questioning about whether the mandate exceeds the government’s constitutional authority.

Reform advocates contend that the mandate is vital to the law’s main objective of extending healthcare coverage to more than 30 million uninsured Americans.


Administration officials have spoken openly about possible contingencies in the past.

At a Reuters Health Summit last May, Health and Human Services Secretary Kathleen Sebelius said there would be a number of ways to expand health coverage if the mandate were overturned.

“There are all kinds of sign-up possibilities, auto enrollment and a variety of strategies,” she said.

But analysts say the week’s proceedings may have left Obama in too fragile a position to speak publicly about contingencies.

The White House could undermine his political base by openly preparing for defeat, particularly on the mandate, which is interwoven with popular consumer protections including a measure guaranteeing healthcare access for people with pre-existing conditions.

“They can’t risk having the president look like he’s folding, or giving up, or anything like that,” said Joseph Antos of the conservative American Enterprise Institute.

If the court struck down the law or its main provisions, analysts say the White House would likely postpone any decision on how to move forward until after the Nov. 6 general election.

They add that the loss of the mandate alone could leave the healthcare law at the mercy of congressional gridlock months after the election and raise doubts about the administration’s ability to usher key reforms into place by a Jan. 1, 2014, deadline. (Editing by Xavier Briand)