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HCAF Requests Additional Extended Review of Medicaid TPA Proposal…Add Your Agency to the Letter!

Monday, July 6, 2020   (0 Comments)
Posted by: Kyle Simon

HCAF is calling on home health agencies to sign on in support of a coalition letter to the Agency for Health Care Administration (AHCA) regarding an issue that she be of great concern to Medicaid providers. Please review the issue background below. If your organization supports HCAF's position on this issue and would like to sign on to the letter in support of our request, please click here to complete the online agreement form by Friday, July 10 at 12:00 PM ET.

Background

Sunshine Health, among the largest health plans in the Statewide Medicaid Managed Care (SMMC) program, recently issued a Request for Proposal (RFP) to Third Party Administrators (TPAs) and Delegated Authorities to manage all of its medical equipment, medical supply and home health services. Earlier this year, Sunshine Health acquired WellCare of Florida, another SMMC health plan. Combined as one entity, Sunshine Health oversees Medicaid-funded health care for nearly four out of 10 Floridians enrolled in the SMMC program — more than one million members — effectively making it the largest Medicaid plan in the United States.

HCAF is concerned about potential risks, and pitfalls, as providers witnessed in 2015 when Univita, a now-shuttered TPA, declared Chapter 7 bankruptcy. The fallout of Univita resulted in providers being left in harm’s way and subject to extraordinary financial burdens. All told, several health care providers and other downstream subcontracted providers were forced to close their doors in the wake of the company's collapse. This also left tens of thousands of Medicaid-insured patients without access to the care they desperately needed.

Letter of Request

In its letter to AHCA, HCAF is requesting that Medicaid officials take another look at the Sunshine Heath RFP and give everyone, including patients and the provider community, more time to digest what this could mean for Florida. Our requests in the letter include the following safeguards:

  • No Delegated Authority or Subcontractor Should Be Allowed to Self-Refer – There are invited respondents to the RFP that self-refer, meaning they authorize business to companies they have an ownership interest in. This has a negative impact on existing providers statewide and reduces the level of service to Medicaid recipients.
  • Preferred Provider Payment Benefit – Some TPAs offer exceedingly low rates to providers throughout the state so low that providers cannot accept the contracts and offer higher rates to providers with which they have a relationship. The preferred providers gain the benefit of consistent business while being more highly compensated. That type of network lock-out and preference cannot be allowed in a taxpayer funded program. AHCA should not allow any sole source arrangements by the delegated authority or subcontractor to ensure quality patient choice and positive outcomes.
  • Following Compliance Guidelines – Many Delegated Authorities have created their own guidelines in excess of Medicaid guidelines, such as capping the rental of equipment that is not capped in Medicaid. Provider’s pricing is formulated to meet the Medicaid pricing guidelines and once some of their items are capped, providers are still expected to service that equipment. Medicaid guidelines should be the required standard.

Add Your Organization to the Letter

If your organization supports HCAF's position on this issue and would like to sign on to the letter in support of our request, please click here to complete the online agreement form by Friday, July 10 at 12:00 PM ET.

Please direct inquiries via email to reception@homecarefla.org or call (850) 222-8967.


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