'This train has left the station'

Sunday, September 25, 2011

TALLAHASSEE, Fla. - HME stakeholders here in August continued efforts to ensure that providers don't get left out when the state moves Medicaid beneficiaries into managed care.

"We have opened a dialogue with the insurance industry," said Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services. "We are doing what we can to move things forward in a proper way."

In May, lawmakers passed two bills to expand Medicaid managed care program beyond its current five counties to include virtually all beneficiaries.

That includes securing an "any willing provider" provider provision for HME providers who wish to participate in the managed care plans. What that means is that any accredited HME provider who agrees to the new pricing can work with different managed care organizations and provider service networks. 

"There is a possibility that some providers could not afford the pricing," said Schwinghammer. "If people are smart, if they consolidate properly, they will be able to meet the prices."

CMS still has to approve the state's Medicaid plan--Medicaid officials submitted a waiver request in August--but Schwinghammer says it's as good as done.

"I believe other than refinements on what exists, you are not going to stop it," he said. 

In recent weeks, various physician and pharmacy organizations have appealed to lawmakers to not allow the plan to move forward. Too little, too late, says Schwinghammer.

"This train has left the station," he said. "It's already law."