Fw: HMOs Florida's Med Waiver Petition

[Guest guest]

From: mikecoonan@...To: NOEWAITSC Subject: HMOs Florida's Med Waiver Petition

Date: Tue, 16 Nov 2010 20:18:52 -0600

To Left Behind and friends

We are getting a lot of information about the reforming Florida's Medicaid Program proposal. Mike

PLEASE SIGN THIS PETITION TODAY!

http://www.petitiononline.com/STOPHARM/petition.htmlThe Florida legislature's current proposal to start a statewide HMO managed care program that combines Medicaid acute and preventative healthcare, ICF/MR, and Home and Community Based Medicaid Waiver Services for persons with developmental disabilities will cause GREAT HARM to those of us on the HCBS Medicaid Waiver who want to keep living in the community! HMO managed care for services will create serious problems such as:1. Reduced services, 2. Lack of consumer choice, and 3. Reduced funding for services HMOs will require that funding for services be SHIFTED to the HMOs administration of the system. According to a Nov. 15, 2006 Wall Street Journal article: “when states run their own Medicaid program they traditionally spend an average 4% to 6% on administrative costs and spend 94% to 96% to pay for services.” The Agency for Persons has just starting implement ibudgets which IS managed care. Ibudgets have a history of saving a lot of money in other states. PLEASE give ibudgets a chance to work before considering the horrible idea of HMOs to manage home and community based services for the most vulnerable Floridians with developmental disabilities.

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MEMORANDUM TO: Members of the Florida House of RepresentativesFROM: Dean Cannon, Speaker-DesignateDATE: November 12, 2010RE: Draft Medicaid Memorial As you know, during our meeting last week incoming Senate President Haridopolos and I agreed that the House and Senate should clearly identify the direction for reforming Florida's Medicaid Program. Attached please find a draft copy of a Joint Memorial on Medicaid. The draft language sends the clear message that the House will build on the plan developed last year based on expert advice and extensive input from providers and other stakeholders. In addition to the statement of principles for reforming the Florida Medicaid Program, the memorial indicates that the Florida Legislature will consider reforms to the civil justice system to reduce disincentives for serving Medicaid participants. Looking beyond future actions in state law, the memorial also calls on Congress to change Federal law to provide states with flexibility in administering the Medicaid program. I look forward to discussing this important issue further when we convene in Tallahassee in just a few days. ======================================= A memorial to the Congress of the United States, urging Congress to amend Title XIX of the Social Security Act and declaring the intent of the Florida Legislature to amend Florida Statutes related to the Florida Medicaid program. WHEREAS, the Constitution of the United States establishes a limited Federal Government and guarantees the rights of individuals and the rights of states, and WHEREAS, the Florida Constitution requires a balanced budget and establishes the foundation for the state's fiscal responsibilities, and WHEREAS, the Medicaid program was established in 1965 as a federal and state partnership, based on shared responsibility, distinct authority, and mutual financial participation, and WHEREAS, Florida's Medicaid program has operated for 45 years with authority to determine eligibility, define covered services, and set payment levels, and WHEREAS, decisions by the Florida Legislature about Medicaid must be made after consideration of the ongoing tax burden carried by Floridians, the state's available resources, and other state obligations, and WHEREAS, the federal Patient Protection and Affordable Care Act eliminates state discretionary powers over eligibility by mandating coverage of at least 1.8 million new enrollees in Florida and prohibiting any changes to current eligibility standards, andWHEREAS, the Patient Protection and Affordable Care Act further hinders the state's ability to manage its resources by mandating previously optional services, requiring specific payment levels to certain providers, and imposing numerous additional administrative requirements, and WHEREAS, the cumulative effect of new federal requirements is to commandeer an increasing amount of Florida's resources while leaving the state with few options for cost containment or program improvement, and WHEREAS, Florida's current Medicaid program is expected to cost over $20 billion per year, including $5.5 billion in state funds and will require more than $2.5 billion in additional general revenue to meet current commitments in the next three fiscal years, and WHEREAS, additional requirements imposed by the Patient Protection and Affordable Care Act will add nearly another $1 billion more to the state's financial obligation by 2016, require an escalating state financial commitment, and disallow essential means of state fiscal control, and WHEREAS, the performance of Florida's Medicaid program is undermined by limited physician participation, complex programmatic design, extensive fraud, and inadequate quality controls, and WHEREAS, Medicaid participants are poorly served by a program that cannot deliver coordinated and accessible health care, and WHEREAS, the future of Florida's Medicaid program requires the delivery of more effective and affordable services to a growing, diverse, and aging population, and WHEREAS, the rebuilding of Florida's Medicaid program is best accomplished through extension and modification of the current Medicaid reform waiver WHEREAS, the Agency for Health Care Administration is negotiating pursuant to chapter 2010-144, Laws of Florida, an extension of the current Medicaid reform waiver beyond its 5-year term, and requires additional legislative guidance to successfully complete the negotiation WHEREAS, the objectives contained in this Memorial are meant to be instructive to the Agency for Health Care Administration in its negotiations for the extension of the Medicaid reform waiver WHEREAS, the Florida Legislature intends to transform the Florida Medicaid program into a statewide integrated managed care program for all services, NOW, THEREFORE, Be It Resolved by the Legislature of the State of Florida: (1) That the Florida Legislature urges Congress to amend Title XIX of the Social Security Act in order to re-establish a fair and prudent federal-state partnership that respects the constitutional requirements and fiscal constraints of each government and enables states to provide cost-effective health care services to low-income residents. (2) That the Florida Legislature urges Congress to re-structure the Medicaid program based on the following principles: (a) The federal-state partnership for Medicaid should be modeled on the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 with federal funding distributed based on population and tied to specific goals and objectives, allowing each state the freedom to craft a Medicaid program that meets the needs of its residents. ( Participants should be empowered to use the public resources provided for their health care to purchase private health insurance when they determine such insurance better meets their needs. © A focus on prevention and cost-effective use of services should be established by fostering personal responsibility and rewarding healthy behaviors. (d) Decision-making should be decentralized in order to allow providers and plans to compete to deliver better value to consumers through innovative service packages, organizational forms, delivery systems, and payment methods. (e) Participants should be given every opportunity to achieve optimal health through systematic, transparent and continuous outcome measurement and quality improvement. (3) That the Florida Legislature resolves, even without the federal reforms described herein, to adopt comprehensive legislation in the 2011 regular session to accomplish the following objectives: (a) To improve program performance by expanding key components of the Medicaid managed care pilot program statewide while strengthening accountability for improved patient outcomes and preserving meaningful choices for participants. ( To improve access to coordinated care by enrolling all Medicaid participants in managed care except those specifically exempted due to short-term eligibility, limited service eligibility, or institutional placement. © To enhance fiscal predictability and financial management by converting the purchase of Medicaid services to capitated, risk-adjusted payment systems. (d) To use the expertise of managed care organizations, including both health maintenance organizations and provider service networks, to provide all coverage and services for medical assistance and long-term care, including home and community-based services. (e) To make the state a more prudent purchaser through use of regional, competitive procurements to select, based on quality and price, a limited number of managed care organizations, including at least one provider service network in each region. and (f) To protect participants' choices and dignity by expanding the use of the opt-out provisions of the pilot program and by allowing Medicaid funds to be used for any state-regulated private coverage, rather than limiting this option to employment-based health benefits. (g) To phase in the implementation of the statewide managed care program, allowing adequate time for development of managed long-term care and reserving the final phase of the implementation of managed care for persons with developmental disabilities. (4) That the Florida Legislature resolves to enact reforms that establish a more fair and predictable civil justice system which reduces disincentives for serving Medicaid participants. BE IT FURTHER RESOLVED that copies of this memorial be dispatched to the President of the United States, to the President of the United States Senate, to the Speaker of the United States House of Representatives, and to each member of the Florida delegation to the United States Congress.