Florida has invested millions of dollars in improving health care costs and transparency.
However, Governor. Ron DeSantis State lawmakers reject $750,000 Health and Medical Agency Administrative Budget for competitive procurement of an independent study to evaluate the usefulness of data currently collected.
Specifically, the Legislature directed that the study must include all costs incurred for such tools for at least each of the last three state fiscal years and must consider current development and redesign efforts, including contract compliance.
The provisos attached to the spending line item included a lengthy list of requirements for the study, including examining state claims databases and how they compare to the current state of the health insurance marketplace; evaluating how the information collected might affect health care decisions made by consumers, the public sector, employers and researchers; and providing a trend analysis of website engagement metrics, including top data comparisons and searches.
However, the language would have required the AHCA to submit an investigation to the chairman of the Senate Appropriations Committee., It will report to the chair of the House Appropriations Committee and the office of the Governor’s Office of Policy and Budget by Dec. 31.
Governor DeSantis also rejected $1 million from the AHCA budget that lawmakers agreed to spend to competitively procure an evaluation of the Medicaid program’s payment transactions for health care benefits and administrative costs reported for purposes of the 2020, 2021 and 2022 Accomplished Savings Rebate (ASR) program.
The ASR program is Statewide Medicaid Managed Care Programs The law also included provisions to ensure that Medicaid managed care plans do not make excessive profits.
The ASR is set by determining pre-tax income as a percentage of revenue. Under Florida law, the plan retains all gains up to 5% of revenue. Half of gains above 5% to 10% of revenue are retained by the plan and the other half is returned to the state. All gains above 10% are returned to the state.
Plans can keep an additional 1% of revenue if they meet or exceed quality standards defined by the AHCA, which include the plan’s track record in managing complex chronic conditions that have a high likelihood of repeat high-cost medical care treatment.
A proviso to the rejected budget required that the study include, at a minimum, a comparison of the amount and related percentage of payments to Medicaid managed care plans contracted within medical loss ratios with the standard medical procedure code levels of other Medicaid providers.
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