Florida Legislation Would Set MCO Rate Floor

Legislation in both chambers of sunshine state’s legislature would set minimum MCO reimbursement at Florida’s current Medicaid DME fee schedule.

Florida’s House and Senate are respectively reviewing two bills, H.B. 1165 and S.B. 1540, which would set a minimum reimbursement rate for the state’s Medicaid managed care organizations (MCOs).

The bills would require the state’s Medicaid managed care organizations (MCOs) to set the minimum reimbursement rates for DME at Florida’s current Medicaid DME fee schedule, according to the American Association for Homecare. The bills would also prohibit MCOs from referring members to subcontractors in which they have an ownership stake or profit-sharing arrangement.

AAHomecare’s Vice President of Payer Relations Laura Williard shared details about the legislation and called for grassroots action at the Florida Alliance of Home Care Services (FAHCS) legislative conference, which was held Feb. 16-17 in Tallahassee.

Williard and FAHCS members met with 21 state lawmakers to convey the difficulty state DME providers have in negotiating rates with Managed Care plans due to their size and that the rates for contracts in Florida are 60 percent of State Medicaid Fee Schedules. A rate floor would only raise DME to 0.8 percent of Medicaid State MCO spending, up from 0.67 percent.

“This legislation is critical to the HME industry in Florida,” Laura Williard said, “Passing these bills will ensure we can continue to partner with the Medicaid managed care plans in ensuring quality care in a sustainable reimbursement model. AAHomecare and FAHCS would like to thank Representative Andrew Learned and Senator Shevrin Jones for their support in championing our legislative efforts.”

AAHomecare encouraged Florida DME stakeholders to contact their lawmakers before the state’s legislative session ends March 11. Florida DME supporters can send a letter to their state lawmakers using the association’s Action Center.

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