Insurance issues dealing with CMS to private insurance.
If you can’t find the information you are looking for or need help with a question, contact the FCA Insurance and Legal Liaison Office.
Last week, the FCA reported on Florida’s Freedom First budget which provided $600 million in funding to AHCA for reportedly increased reimbursements for the sole purpose of increasing the minimum wage for “employees” of Medicaid providers to at least $15.00 per hour. Medicaid Providers are required to complete and submit a Supplemental Wage Agreement.
If you are currently a Medicaid provider and wish to continue to be a Medicaid provider, you are required to complete a Minimum Wage Supplemental Wage Agreement, wherein in exchange for receiving what is supposed to be increased reimbursements, you agree to increase your employee’s wages to $15 per hour by January 1, 2023, else face civil action by an employee, an award of the back wages unlawfully withheld, the same amount of an award in liquidated damages, and payment of attorney’s fees and costs to the prevailing party.
On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. The Freedom First Budget provided over $600 million in funding to the Agency for Health Care Administration (Agency or AHCA) for the sole purpose of increasing the minimum wage for employees of Medicaid providers to at least $15.00 an hour.
To distribute the funds appropriated for the Medicaid provider minimum wage requirement, AHCA has been directed to increase Medicaid managed care reimbursement rates and certain Medicaid fee-for-service fee schedules. The Agency is also required to enter into a supplemental wage agreement with each impacted Medicaid Provider by October 1, 2022, to ensure compliance with the minimum wage requirements.
While Florida voters approved Amendment 2 to the Florida constitution on November 3, 2020, to gradually increase the state’s minimum wage to $15.00 per hour by the year 2026, the required minimum wage increase in Florida on September 30, 2022, is $11.00 per hour ($12.00 on 9/30/23; $13.00 per hour on 9/30/24, etc until $15.00 per hour on 9/30/26). Medicaid providers, however, must abide by the State’s Freedom First budget to increase employee wages to $15.00 per hour by January 1, 2023.
THE DEADLINE FOR THE SUPPLEMENTAL AGREEMENT IS OCTOBER 1: This is a reminder that the deadline to enter into the required Minimum Wage Supplemental Wage Agreement with the Agency is October 1, 2022.
Updated Frequently Asked Questions (FAQs): New posting for FAQs to address questions submitted. The updated FAQs can be found here.
Medicaid Minimum Wage Site: https://ahca.myflorida.com/Medicaid/Finance/finance/enh_wage/index.shtml#
QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com
COMPLAINTS OR ISSUES? ON LINE http://ahca.myflorida.com/Medicaid/complaints/ or CALL 1-877-254-1055
(From a Chiropractic Economics report of 05/25/2022) The Claims Journal – a respected insurance industry resource – published a May 18th webpost citing a recent study by the Workers Compensation Research Institute (WCRI) which found that “medical care costs less and claimants return to work more quickly when low back pain treatment is provided solely by chiropractors. Costs were also lower when chiropractors provided physical medicine services but other types of clinicians were in charge of evaluation and management, but the difference was not as dramatic.”
The Claims Journal went on to report:
The CDC updates ICD10 diagnosis codes every October 1. Frequently the update is adding specificity to existing codes. An example pertinent to most chiropractic physicians is Low Back Pain M54.5. This code when billed for dates of service on and after October 1 will rejected as an invalid code by any payer requiring diagnostic coding on bills.
(From a January 20th ACA Press Release) The Competitive Health Insurance Reform Act (H.R. 1418) passed the House of Representatives and the Senate last year and was signed into law on Jan. 13, removing the 75-year-old exemption that allowed health insurance companies to avoid federal antitrust laws.
This alert is to remind Florida Medicaid providers that they cannot charge a recipient for Personal Protective Equipment (PPE) used during the delivery of a Medicaid covered service. Reimbursement from Florida Medicaid is payment in full for all services. Additional information, including balanced billing prohibitions, is located in the Agency’s General Medicaid Policy.
It is often difficult, if not next to impossible, to traverse Florida laws on all times relevant for submitting, receiving, contesting, and payment of insurance claims. Florida’s Department of Financial Services (DFS), Office of Consumer Affairs, has helped some in this regard by summarizing part of the payment of claims statute on their website, of which I have incorporated into this article along with other provisions that are not on the website. Should the need arise, this is also where you go to file an Insurance Complaint. Remember, in filing an appeal to a claim for overpayment or a denial, there are time limitations involved.
The recent Florida Blue announcement expanding their chiropractic network management business to the Federal BCBS Plans with American Specialty Health (ASH), has raised many questions and calls have abounded. We reached out to Florida Blue for answers to the most frequently asked questions. Here is what they said:
Last week Florida Blue announced its expansion of American Specialty Health Group, Inc. (ASH) network management for its Preferred Patient Care and Traditional (PPS) networks. Per Florida Blue’s notice, “This includes those in the Federal Employee Program® and members of other Blue Cross and/or Blue Shield plans accessing through Blue Card®.” This has caused a number of member calls from those concerned about the expansion.
