5 Things Florida: PBM regulations, Q&A w/ Ashley Grimes, Dept. of Health RFI

By

Emily Boerger

|

In this edition of “5 Things We’re Watching,” we feature a conversation with NAMI Florida’s Ashley Grimes, dive into the details of a new RFI from the Office of Children’s Medical Services, and take a look at new health policies that went into effect last week.

Thanks for reading!

Emily Boerger
State of Reform

 

1. Q&A: Ashley Grimes, NAMI Florida

Ashley Grimes is the President of NAMI Florida, the state affiliate of the National Alliance on Mental Illness. Working with 24 affiliate communities statewide, NAMI Florida provides education, advocacy, and care coordination for people with mental illnesses and their loved ones. In this Q&A, Grimes highlights the ways Florida can strengthen its behavioral health system in the context of gun violence, workforce shortages, and more.

Grimes says the rollout of 988, the 3-digit national suicide prevention and behavioral health crisis hotline, this month is a major step forward, particularly with support from law enforcement. “A lot of law enforcement agencies have gotten on board [with 988] … Their job isn’t to be mental health professionals. It’s not what they trained in. That’s not their specialty. They want the help, and they’ve really gone above and beyond to try to advocate [for 988].”

 

2. New PBM regulations now in effect

A bill establishing new regulations for pharmacy benefit managers went into effect on Friday. The law creates protections for Florida pharmacies related to PBM audits and establishes a $10,000 financial penalty for PBMs that fail to register with the Office of Insurance Regulation.

The new policy, known as the Florida Pharmacy Act, is one of about 145 new bills that went into effect on July 1st. Other health-related bills on the list include SB 312, which expands the types of prescriptions allowed via telehealth, SB 282, which aims to increase the use of peer specialists, and HB 855, which sets up new performance accountability requirements for Medicaid managed care plans.

 

3. What They’re Watching: David Muhlestein, Health Management Associates

David Muhlestein, PhD, JD, is the Chief Research and Innovation Officer for Health Management Associates, where he leads the firm’s self-directed research and supports strategic planning and innovation. In this edition of “What They’re Watching,” Muhlestein discusses the challenges, opportunities, and outlook for health organizations shifting away from fee-for-service models to value-based care.

While COVID-19 caused some organizations to delay the shift to VBC, Muhlestein says the pandemic ultimately showed the value of these payment models. “True value-based prospective payments were really advantageous for people during COVID. If you were already under those models, you were better off. It’s going to be a chance for people to say, ‘We learned a lot during COVID. While we’re starting to think about what’s next, let’s go back to value-based care and double down on that.’”

 

4. Experts discuss innovations in elder care

Improved care coordination, technological investments, and the social determinants of health were all discussed during a panel focused on elder care at the State of Reform conference. During the conversation, 4 elder care experts identified flaws in the current system and brought attention to innovative solutions.

One widespread issue, says AARP Florida State Director Jeff Johnson, is the limited community services available to seniors—particularly in rural parts of the state. “[Seniors] would love to be able to remain independent at home in their community,” Johnson said. “Our systems aren’t set up that way. We can talk about that in terms of long-term care systems and the Medicaid bias towards nursing home placement versus home and community-based services.” Coverage of their full conversation is available here.


5. DOH releases RFI for Children’s Medical Services Managed Care Plan

The Office of Children’s Medical Services, through the Florida Department of Health, released a request for information last week seeking input on innovative service delivery practices for children and youth with special health care needs (CYSHCN).

The RFI outlines several care management goals that respondents should strive to address in their responses. These goals include improvements to pediatric dental care, increased use of value-based payment designs, focused attention on health inequities for diverse CYSHCN, and improved behavioral health access and outcomes. Responses are due to DOH by 5 pm Eastern Time on Aug. 2nd, 2022.