FAHCS ADVOCACY WINS & UPdates

Advocacy Goals 2024-25

This document outlines the Florida Alliance of Health Care Services' (FAHCS) advocacy priorities and action items for 2024-2025. Key areas of focus include agency engagement on AI auditing processes, fee schedule recommendations, and addressing ITN (Invitation to Negotiate) issues. Legislative priorities for the 2025 session include advocating for 100% reimbursement, introducing rate floor legislation, prohibiting self-referrals, and streamlining prior authorization processes to guarantee payments.

Ongoing goals emphasize collaboration with legislators, agencies, and patient advocacy groups, addressing challenges in managed care contracts, exploring AI's impact on the DME space, and advocating for improved payments for Complex Rehabilitation Technology (CRT). FAHCS aims to position itself as a key resource for legislative and regulatory issues while fostering state and national collaboration with organizations like AAHomecare and VGM.

FAHCS Town Hall for ALL Florida Providers
October 24, 2024

Quick recap

The first Town Hall meeting for FAHCS was held to gather feedback from DME providers in Florida, focusing on advocacy and legislative plans. The meeting also addressed concerns related to Medicaid Waiver programs, issues with Staywell, the third-party administrator for Medicaid, and the challenges faced by providers. Future plans include a rescheduled legislative meeting, addressing advocacy goals for the 2025 timeframe, and a potential trip to Tallahassee in early February.

Next steps

• Beth to send announcement about the rescheduled legislative meeting dates (February 11-12).
• Hector to find out who will be taking over the Staywell contract for Medicaid administration.
• FAHCS board to continue working on advocacy goals: rate floor, no self-referral, and prior authorization as guarantee of payment.
• FAHCS team to organize and promote attendance for the upcoming Tallahassee legislative meeting in early February.
• FAHCS board to gather feedback on the town hall meeting format for potential future sessions.

Summary

FAHCS Town Hall Meeting Begins

In the meeting, Beth initiated the first Town Hall meeting for FAHCS, welcoming both current and prospective members. Hector, the president of FAHCS, introduced the purpose of the meeting, which was to reach out to all providers and understand their concerns. He encouraged non-members to introduce themselves, and June from Affordable Medical Supply and Maury joined the meeting. Hector expressed his intention to address the concerns of all participants, including those not currently part of FAHCS.

Florida DME Advocacy and Legislative Plans

Hector initiated a meeting to gather feedback from DME providers in Florida, focusing on advocacy and legislative plans. He highlighted the importance of addressing concerns and building relationships in Tallahassee. Laura Williard, a senior VP of payer relations for AAHomecare and a long-standing FAHCS board member, echoed Hector's sentiments, emphasizing the importance of relationship building and persistence in legislative efforts. She also mentioned the departure of Tom Wallace from ACHA, which may require rebuilding relationships with the new administration. The conversation ended with the anticipation of future challenges and the need for continued advocacy work.

Rescheduled Legislative Meeting and Advocacy Goals

Laura discussed the upcoming legislative meeting, which was rescheduled to February 11 and 12 due to the General Assembly's absence in January. She also outlined the advocacy goals for the 2025 timeframe, which include a rate floor for managed care plans, the elimination of self-referral practices, and a guarantee of payment for prior authorization. Laura also mentioned the work group that was formed to address issues in both Medicaid and Medicare. Hector suggested addressing concerns related to Medicaid Waiver programs.

Frustration With Staywell and Medicaid

June expresses frustration with Staywell, the third-party administrator for Medicaid, citing issues with provider relations and renewing her Medicaid number after it was hijacked during COVID. She is concerned about who will replace Staywell after December 31st and hopes the new administrator will be better. Gene encourages everyone to share their issues, big or small, so FAHCS can address them.

StayWell Contract and Lobbyist Update

Hector and Tom discussed the challenges faced by providers, particularly with GameWell, a contract with ACHA. They agreed to find out who would be taking over the StayWell contract and to address the issue. Tom, the main contact through the Administration, was introduced as the current lobbyist. Tom outlined his firm's role in representing the Association, focusing on nurturing and maintaining strong working relationships with leadership. He also mentioned the recent resignation of the Medicaid director, Tom Wallace. Hector suggested having more town halls if beneficial for everyone and encouraged feedback. A future trip to Tallahassee - February 11-12 was also mentioned.

Florida Medicaid Fee Schedule 7.3%
Increase Effective Oct. 1

November 27, 2023

FAHCS alerted members just before Thanksgiving & thanks to our hardworking team led by Laura Williard (AAHomecare) & Tom Griffin (FAHCS Lobbyist) - without your hard work and leadership, would not have been possible!  

AAHomecare officially reported today that Florida AHCA released their updated DME Medicaid fee schedule based on state budget legislation that provided the first broad-scope DME reimbursement increase in 23 years. The increase works out to 7.3%, based on funds allocated by legislators to the Florida budget.

Providers will have to resubmit claims from 10/1/2023 to get the earlier claims reprocessed at the higher rate.  Funds were also provided to the MCO plans to provide rate increases to DME providers. If a provider’s fee schedule is not based on the updated Florida Medicaid FFS fee schedule or it is not at 100% of the fee schedule rates, contact the MCO plan to negotiate their contracts to ensure receiving the full 7.3% increase.  

As we shared when first announced in May, the historic increase follows a persistent four-year advocacy effort by AAHomecare’s Payer Relations team and FAHCS. While the rate change was originally described as a 7.5% increase by Florida officials, the 7.3% number reflects the dollars ultimately allotted by the legislature.

See the new Florida Medicaid DME fee schedule here

FAHCS ARPA PAYMENTS

July 21, 2023

More information on the FAHCS WIN...

19% ARPA Payments

Good news for your Friday!! FAHCS reported previously that by working with AHCA, we were able to obtain a 19% ARPA Payment based on payments received 7/1/2021 – 6/30/2022 and now we have more details to share. 

1) ARPA 19% One Time Payment - the payment is based on an AHCA analysis of one year's worth of claims payments between provider and plan.   the 19% payment is based upon the actual payments paid out over that one-year period of 7/1/2021 – 6/30-2022. The payment amount is NOT based on the fee schedule amounts. The specific amounts were prescribed by AHCA, so the plans have zero latitude in calculating their own 19% payment amounts. The additional money providers will be receiving was calculated by AHCA and NOT THE PLANS.

2) Payment Deadline—all $181M has been distributed to the plans and there was a June 30^thdeadline for distribution in the original public notice to the providers (shown below). Furthermore, AHCA will NOT claw back any of these funds, so providers should proceed with forecasting that includes the full amount of the 19% payment amount. None of the funds will be returned.

3) Payments by June 30 – if you have NOT received any payments from Plans by now, you should use the contact information below provided in the public notice and contact EACH PLAN to make sure payments are made to your company.  We have heard from some FAHCS members who have sought out their payments by this method and HAVE been paid.  Regarding TPAs: AHCA did not limit nor require payment distributions one way or the other. So, payments may come from both the plans or TPAs where applicable. (Tom Griffin spoke to Coastal and they will be distributing funds on behalf of the plans they serve.) 

4) Payment & Taxation – to date, FAHCS has not received information on the taxation of these payments.  Please research with your legal counsel for more information. 

NOTICE:  FAQ for ONE-TIME Retention Payment for Non-HCBS Waiver payments

THANKS TO FAHCS and the hard work in partnership with AAHomecare’s Laura Williard - this is a HUGE WIN FOR FAHCS Members and Florida Providers.   Laura shared, “We are thrilled to be able to secure this funding and our associations together will continue to be a resource for you.” Beth Bowen adds, “Another resource for you is the jammed packed agenda filled with education at our Annual Meeting in Orlando August 1-2, including input from payers.  Come join us!”   SIGN UP HERE

June 12, 2023

FAHCS continued partnership with AAHomecare on many efforts once again pays off - ARPA Retroactive Relief of 19% Applies to Medicaid Claims from July 1, 2021 through June 30, 2022 ~ AAHomecare reports Florida’s Agency for Health Care Administration (ACHA) is granting one-time payments to providers of Home and Community-Based Services (HCBS), including DME, calculated as a 19% increase based on Medicaid payments made by the MMA (managed medical assistance) plans on a range of codes over July 1, 2021 through June 30, 2022.  The relief is possible thanks to the funding provided by the American Rescue Plan Act (ARPA), which went into effect April 1, 2021. The payments do not require any application or reporting from eligible suppliers.  ACHA notes that “payments have been disbursed to the plans and the plans will then have 30 days to make disbursements to eligible providers.” Last year, Florida granted relief to Provider Type (PT) 67 DME suppliers who provide services under the waiver programs in Florida. This round of relief is for PT 90 suppliers, which is essentially all DME providers.  The relief is based on billings for A,B,E,K, and T HCPC codes; L codes (O&P products) are not included in the calculations. The win is particularly satisfying for Florida DME leaders who began working on a plan to seek a share of ARPA relief even before the funding mechanisms were finalized at the federal level. “Florida is the first state AAHomecare began working with to seek ARPA-based relief,” said Laura Williard, AAHomecare vice president of payer relations [and FAHCS Board Member].  “On April 27, 2021 we sent a letter cobranded with FAHCS to the Governor’s office asking for a 20% retroactive increase based on one year’s claims.” “Following the request, we continued to work with FAHCS leaders and their lobbyist, Tom Griffin, to build awareness and support for ARPA relief for DME suppliers with Florida policymakers, meeting regularly with AHCA officials and representatives from Governor DeSantis’ office,” added Williard. “Tom Wallace, AHCA deputy security for healthcare finance and data, deserves special recognition for understanding of the value DME delivers for all Florida residents and support during this effort.” The ARPA relief follows on last month’s 7.5% Medicaid fee schedule increase for Florida DME suppliers, which goes into effect on October 1, 2023. See more in Friday's Florida AHCA announcement and related FAQ document Beth Bowen (FAHCS Executive Director) boasts, "FAHCS is very fortunate to have such a dedicated and hard-working advocacy team led by FAHCS Board Member, Laura Williard (AAHomecare) and Tom & Keaton Griffin (FAHCS Lobbyists).  Tireless efforts by the entire team over the last few years are finally paying off with this significant ARPA win and just last month, the 7.5% Medicaid fee schedule rate increase was confirmed and will take effect October 1, 2023." You may have some questions regarding how this will be implemented and we will be providing more insight as we know it.