URGENT! - HMO'S TO RUN MEDWAIVER - WILL BE DEVASTATING

[Guest guest]

If you do nothing else today, please read this. We are planning a rally in Tallahassee on Wednesday, April 14 and possibly Thursday, April 15.

The effects of these proposed bills will be devastating to the DD population. Having gone through several years of cuts, changes in funding structure, tiers and the proposed iBudgets how does Representative Cannon, Senator Haridopolos and the leadership expect the most vulnerable in our society to survive? To expect HMOs to be able to serve this population appropriately, without any prior experience of doing so is ludicrous. The HMO plan will have a limited choice of providers and scope of services without the cost efficiencies of the current system and the new iBudget system, that hasn’t even been implemented yet. Furthermore, the iBudget system already has managed care principals included in it. Lastly, quality of care will be compromised with the HMO plan. This population is not a simple one to serve. The legislature obviously, only wants to accomplish one thing, to cut services further with no regard to the well-being of the DD population.

We must not allow this to happen!

House Proposal for Managed Care for People with Developmental Disabilities

Two bills have been drafted by the House Select Policy Council on Strategic & Economic Planning (Rep. Dean Canon, Chair) that will require all purchased services to people with developmental disabilities (DD) funded through Medicaid be administered by a Health Maintenance Organization (HMO) or Provider Service Network (PSN). The drafts will become a proposed committee substitute (PCB) on Monday April 12 and can be expected to go directly to the floor of the House. The Senate is expected to consider this or another similar plan next week. There was early warning that bills of this scope would surface this late in the legislative session.

Key Features of the Bill

1. All purchased Medicaid services will be under managed care. There will be no exceptions or “carve outsâ€.

a. For people with developmental disabilities, this includes all Waiver services, all private Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) services and all acute care services.

2. The effective date for HMOs or PSNs to begin delivering services to people with DD is 2015.

3. The state will be divided into six areas with at least two HMOs and one PSN managing services in each area.

4. The tier system is perpetuated as it is now defined except that a fifth tier is added for services provided by private ICF/DDs. There is no mention of iBudgets.

5. The managed care entity is expected to save 8% of the current cost of care with a preferred savings of 15%. These savings will come on the backs of the DD population. There is no way to achieve these savings through HMOs. The fact is the current administrative costs through AHCA and APD are less costly than HMOs. They are promising the state savings at the expense of quality of care to our sons and daughters. The savings will come out of cost plans and service cuts, not true savings to the state.

a. The savings will be used to pay for the cost of the HMO or PSN.

b. No additional funds can be expected.

c. Unlike in the case of acute care or traditional nursing home care, there is no clear rationale as to how these funds will be saved.

6. The Agency for Persons with Disabilities functions will be limited to managing the two remaining state institutions, the forensic programs and a small general revenue program as well as those functions delegated to it by the Agency for Health Care Administration (AHCA).

7. Case management will be provided by the HMO or PSN. Independent support coordination will be eliminated.

8. The HMOs and PSNs will have no responsibility for serving people on the waiting list. In other words, unlike some managed care programs, there will be no “take all comers†responsibility.

Impact

1. There will be an immediate 15% reduction of services or a reduction in the rates paid for those services. How can the legislature justify another cut in rates or services? The previous cuts have all but gutted the system already. Any more cuts will cause the providers that are left to pull out of the state and ultimately, leave many without a place to live.

I guess we can ask Representative Cannon, Speaker Cretul, Senator Haridopolos and other leaders if they are willing to house our sons and daughters in their homes, since many will be left homeless.

2. The loyalty of case managers will be shifted from the consumer to the managing entity.

3. Even if the iBudget is incorporated into the plan, the authority for making decisions on what services are purchased will be in the hands of the managing entity. The concept of consumer and parent empowerment will essentially end.

4. APD will be reduced to a small office having minimal impact on the policies related to service delivery. Area offices will probably cease to exist.

5. Private HMOs have no experience in long term care for people with DD and no experience in a system which has already accomplished diversion from high cost institutional care. HMOs will be learning what to do “on the job†something people with DD should not have to endure. No other state has placed the care of people with DD in the hands of private HMOs. The few that are using HMOs have used government related agencies to act as the HMO.

The time is now to say “We are mad as hell and not going to take it anymoreâ€! Don’t allow the legislature to continue to reduce and deny the services that our children and adults with disabilities desperately need. This constant game of bait and switch is ruining peoples’ lives. We will not stand by and allow this to happen.

Call now and tell the following legislators that HMO’s are not the answer for our children and adults with disabilities and to vote against PCB 10-03 or at the very least, remove the DD population from the bill.

House Members to contact – CALL FIRST, EMAIL AND FAX IF POSSIBLE.

First Name

Last Name

District City

Local Phone

Email Address

Dean

Cannon

Winter Park

dean.cannon@...

Larry

Cretul

Ocala

larry.cretul@...

Anitere

Miami

anitere.flores@...

Jim

Frishe

Belleair Bluffs

james.frishe@...

Bill

Galvano

Bradenton

bill.galvano@...

Adam

Hasner

Delray Beach

adam.hasner@...

Ed

Homan

Temple Terrace

ed.homan@...

Paige

Kreegel

Punta Gorda

paige.kreegel@...

-Cantera

Miami

carlos.lopez-cantera@...

Nehr

Tarpon Springs

peter.nehr@...

Ron

Reagan

Sarasota

ron.reagan@...

Senate Members to contact – CALL FIRST, EMAIL AND FAX IF POSSIBLE.

First Name

Last Name

District City

Local Phone

Email Address

JD

Lake Wales

alexander.jd.web@...

Jeff

Atwater

North Palm Beach

atwater.jeff.web@...

Don

Gaetz

Destin

gaetz.don.web@...

Andy

Gardiner

Orlando

gardiner.andy.web@...

Dan

Gelber

Miami Beach

gelber.dan.web@...

Mike

Haridopolos

Melbourne

haridopolos.mike.web@...

Joe

Negron

Palm City

negron.joe.web@...

Durell

Peaden, Jr.

Crestview

peaden.durell.web@...

Ring

Margate

ring.jeremy.web@...

Ronda

Storms

storms.ronda.web@...

Thrasher

ville

thrasher.john.web@...

J.

Villalobos

Miami

villalobos.alex.web@...