Industry fights on new level

Monday, April 30, 2007

TALLAHASSEE, Fla. - Fed up with continuous denials and payment delays, clinicians and providers of complex rehab have decided to go over the heads of Florida Medicaid. They plan to appeal to Gov. Charlie Crist and Andrew Agwunobi, secretary of the Agency for Health Care Administration (AHCA), which oversees Florida Medicaid. Both officials assumed their posts in January, when former Gov. Jeb Bush left office.
"We plan to present them with files of stories of people who have had horror stories dealing with Medicaid," said Doug Towne, CEO of the Disability Relations Group, which is helping to facilitate discussions between clinicians, providers and the state. "We want them to review the files from two perspectives: Can they solve each individual's problem, and can they see systemic issues that can be resolved?"
Last year, clinicians and providers sent Medicaid officials more than a dozen recommendations for streamlining the program's requirements to reduce denials and payment delays. The recommendations covered everything from eliminating the prior authorization requirement for certain items like power wheelchair motors to mandating training for claims reviewers.
Medicaid's response: Thanks, but no thanks, say members of a workgroup that crafted the recommendations.
"I can't tell you how many hours we put into this--all for nothing," said Tom McEnany, a member of the workgroup and owner of Wheelchairs Plus in Jacksonville, Fla.
For years now, clinicians and providers have been hammered by Medicaid's practice of routinely overriding physicians and clinicians by denying claims for power wheelchairs with certain types of technology, such as seat elevators. They've also been dogged by Medicaid's inefficiency. According to one provider's records: In 2003, Medicaid took, on average, 33 days to notify him whether it had approved a claim. In 2006, it took, on average, 132 days.
Craig Kraft, a member of the committee and director of the seating program at Tampa Shriners Hospital for Children, planned to set up a meeting with Agwunobi during "Shriners Day at the Capitol" in Tallahassee, Fla., March 29.
"We're going to let him know, as patient advocates not concerned with profits, what's going on under his watch," he said.