Today, the House will be taking up its Medicaid reform proposal in draft form for the first time this session. The bills differ from last year's proposal in that medical loss ratios are abandoned in favor of the “achieved savings rebate.” The rebate will allow plans to retain up to 7.5 percent of revenue as pre-tax income, and any revenue above nine percent (or 10 percent for plans that meet certain quality measures) must be refunded to the state. In addition, the proposal requires plans to include all providers in a region that are classified by the Agency for Health Care Administration as “essential providers,” which include, at a minimum, federally qualified health centers, statutory teaching hospitals, trauma centers, hospitals located at least 25 miles from any other hospital with similar services, specialty children's hospitals, faculty plans of Florida medical schools, and regional perinatal intensive care centers. The House proposal still differs significantly from the Senate proposal, S.B. 1972, by employing far fewer regions (seven, instead of 19) and discarding the use of medical loss ratios. In addition, the House proposal does not include any of the tort reforms proposed by the Senate and does not provide for the state to pull out of the federal Medicaid program if the federal government does not approve the waivers necessary to implement the reforms.
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House Medicaid proposals scheduled for a first hearing
- Foley & Lardner LLP
- G. Donovan Brown , Jonathan P. Kilman, Michael P. Harrell, Paul W. Lowell , Robert H. Hosay and Thomas J. Maida
- March 14 2011
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