Florida Medicaid: FAHCS lawyers up

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Friday, June 8, 2018

TALLAHASSEE, Fla. – Fearing another Univita debacle, the Florida Alliance of Home Care Services has retained legal counsel to ensure that the state’s Medicaid managed care contracts are aboveboard.

In April, the Agency for Health Care Administration awarded contracts to 12 health plans in 11 regions, effective Jan. 1, 2019. Of concern to FAHCS and its members: Who will act as the third-party administrators, if any, for the health plans, and who will provide DME equipment and services?

“We want to work closely with the Agency for Health Care Administration to gain transparency on entities that are accepting contracts,” said Chris Townsend, FAHCS president. “Our concern is a monopoly could be formed.”

That’s what stakeholders say happened back in 2014, when Univita gained control of a huge share of the managed care market, contracting with 10 of 14 health plans to administer their HME programs, even though they were an HME provider themselves.

Univita’s model proved unsustainable. AHCA terminated the company’s contracts in July 2015 and the company filed for bankruptcy shortly thereafter.

“One thing that causes heartburn is we are seeing the trend of the different plans all beginning to use the same network manager,” said one provider. “With Univita, it was referring to itself. That really locked out the DME business for other providers.”

As the new contracts are implemented, FAHCS wants to make sure AHCA honors a requirement whereby health plans must identify all subcontractors, and those subcontractors must identify any further subcontractors, the association stated in a bulletin to its members.

“FAHCS is working on a formal inquiry to assure that the ‘non self referring subcontractor’ language survives in the contract,” it stated.