State House backs away from dental change to Medicaid program

The Florida House pulled back Wednesday from a controversial proposal that would have changed how dental care is provided to people in the Medicaid program.

But a bill that would revamp the Medicaid managed care system continued to draw objections from the hospital industry, which is concerned about potential consequences if hospitals cannot reach agreements with HMOs.

The House Health & Human Services Committee voted 15-5 to approve the bill, positioning it to go to the full House. The measure would make a series of changes as the state Agency for Health Care Administration prepares to move forward with a process to award a new round of contracts worth billions of dollars to HMOs and other managed care plans.

The bill initially faced opposition from dentists because of a proposal to bring dental services under the umbrella of the managed-care plans. That would effectively undo a 2016 decision by the Legislature to create a separate Medicaid managed-care program for dental care — known in Tallahassee as a “carve-out” of the services.

The Senate, which is moving forward with another version of the bill (SB 1950), also objected to changing the way dental services are provided, with Senate Health & Human Services Appropriations Chairman Aaron Bean, R-Fernandina Beach, saying last week that lawmakers were on a “collision course” about the issue.

House sponsor Sam Garrison, R-Fleming Island, defused the issue Wednesday by changing the House bill to keep dental services as a carve-out. The revised bill would add requirements aimed, in part, at measuring the performances of Medicaid dental plans. Also, the bill would add a network requirement to try to ensure care for patients with complex dental problems.

“What we are requiring is additional reporting, additional communication between the managed-care plans and the dental providers and also assurances that folks who require that additional care for sedation and complex cases aren’t left out in the cold,” Garrison said.

Joe Anne Hart, chief legislative officer for the Florida Dental Association, supported the change, though she also urged lawmakers to increase payment rates for dentists who provide care to Medicaid beneficiaries.

“The ultimate goal here is to get care for everyone,” Hart said.

The revised bill continued to face objections, however, from two major hospital-industry groups, the Florida Hospital Association and the Safety Net Hospital Alliance of Florida.

They are concerned about a proposal related to what are described as “essential” providers, which could include, for example, public hospitals and teaching hospitals.

Under the bill, those providers would be required to contract with each Medicaid managed-care plan in their regions and, in some cases, throughout the state. They would face the possibility of losing what are known as “supplemental” Medicaid payments if they don’t have such contracts.

Garrison made a change Wednesday to create a mediation process if hospitals and managed-care plans cannot reach agreements. But the bill still leaves open the possibility of hospitals losing supplemental money if they don’t end up with contracts.

“Our biggest concern is that the punishment for the hospitals still seems to be draconian, and as we read the bill, even if there is finding by the independent mediator that the health plan has been acting in bad faith, the hospital still loses its supplemental funding,” said Justin Senior, CEO of the Safety Net Hospital Alliance of Florida and a former secretary of the Agency for Health Care Administration.

Garrison said he wants to ensure that Medicaid beneficiaries have access to care from essential providers.

“Our goal throughout this process, again, is patient, patient, patient, patient. It’s patient-focused,” Garrison said. “And so we want to make sure that with every Medicaid patient in the state of Florida who’s involved with managed care, all 4 million of them, including 60 percent of children in the state of Florida, that when it comes to our essential providers that we have that network adequacy in place for the patient.”

After testing a pilot program, lawmakers in 2011 created a system in which most Medicaid beneficiaries are required to enroll in managed-care plans. The Agency for Health Care Administration has gone through lengthy processes twice to award contracts to managed-care plans and is expected to begin a third round this year.

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