The bill, which is currently passing the Florida House of Representatives, will make changes to five key components of the state’s Medicaid program, which targets nearly five million Florida people. House building 7047The revision will affect the state-wide Medicaid Managed Care (SMMC) program as the Healthcare Administration (AHCA) will implement the next procurement from 2022 to 2023.
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representative Sam Garrison (R – Clay) introduced his bill to the House Health Care Appropriations Subcommittee this week, outlining five key changes it brings.
1. Reprocurement process
HB 7047 approves SMMC re-procurement for the entire state, not regionally. It will also consolidate the number of managed care areas from 11 to 8. According to Garrison, the bill will also promote healthy competition between Medicaid’s health plans by limiting plan enrollment to 45% of total regional subscribers.According to the staff analysisAs of November 30, 2021, there was health insurance with over 45% subscribers in six regions.
2. Dental benefits
One of the more controversial parts of the bill was the restoration of dental services under SMMC. From 2014 to 2018, dental benefits were integrated into the medical plan, during which time the state’s utilization of dental services was high.
However, in 2016 Congress instructed AHCA to split dental benefits into a standalone managed care program. This happened between 2018 and 2019, and staff analysis showed that dental services were suspended or retreated. As of October 2021, three dental programs are currently contracted to provide Medicaid dental services.
3. Network validity
Another section of opposition from House Democrats is about network contracts between regional planning and state-wide essential providers such as hospitals.
Currently, mandatory providers must offer contracts with all applicable Medicaid plans, but do not need to sign contracts to receive additional payments. AHCA is currently acting as a deciding factor on whether these contracts are being made fairly. The bill requires a network contract and removes the AHCA mediator role.
“”[AHCA is] I’m not ready to do that and it’s unfair to ask them to do so, “he said. “What we’re trying to do in this process is to create an objective standard for AHCA to consider … you either have a contract or don’t have one.”
representative Nicholas Durand (D – Miami-Dade) announced the only amendment to the bill. This removes the network contract requirement for the provider to receive additional payments. Durand argued that the amendment “promotes true competition” between the plan and the provider, but in the end the amendment did not pass.
4. Health behavior program
One provision of the bill is Healthy behavior A program that supports the overall health of registrants. Current conditions undertaken under this program include smoking, weight loss, and substance use. The bill will focus on recovering opioid abuse by expanding smoking cessation, including non-smoking tobacco products.
5. Labor development
This part of the bill expands the types of health education funds that may be included in the plan’s medical loss rate (MLR), or the amount of premium income spent on “clinical services and quality improvements,” according to the CMS. increase. Guidelines.. The bill adds funding for graduate and undergraduate nursing education positions and “student positions in any degree or technical program” in addition to the current spending on internship positions. [in] A serious shortage due to AHCA. According to Garrison, this provision will encourage plans to invest in labor development initiatives.
The bill was favorably passed by the Health Budget Subcommittee, with 10-5 votes in line with political party policy, and is now part of the full House Health and Human Services Committee.
