'This train has left the station'

Sunday, October 30, 2011

By Theresa Flaherty, Managing Editor

TALLAHASSEE, Fla. - HME stakeholders here are trying to make sure that providers don't get left out when the state starts using managed care organizations for all of its Medicaid recipients.

"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, state lawmakers passed two bills to expand  Florida's Medicaid managed care program beyond its current five counties to include all recipients.

The industry's efforts include securing an "any willing provider" provision for HME providers who wish to participate in the managed care plans. What that means is that any accredited 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.