In this month’s newsletter we have an interview on care integration with FBHA CEO Melanie Brown-Woofter, a deep dive on Medicare-related provisions in the Inflation Reduction Act, and details on a new RFP for home visiting services providers.
Thanks for reading!
Emily Boerger
State of Reform
1. Inflation Reduction Act’s impact on prescription drugs
In a recent conversation with State of Reform, Zayne Smith, Director of Advocacy at AARP Florida, described how the Inflation Reduction Act will impact Medicare beneficiaries—particularly as it relates to prescription drug costs. Smith offered details on several provisions in the act including the cap on out-of-pocket insulin copays, the provision offering certain vaccines for free, and the ability for Medicare to negotiate certain prices.
Despite these big wins, Smith says more can be done. She’s specifically advocating for federal approval of Florida’s Canadian Prescription Drug Importation Program, which the state legislature first passed in 2019. “The state of Florida has been planning for that for 3 years now and waiting to get that green light. We’ve got the money, it’s been appropriated. The players are in place, we’ve just got to get the green light to do it as a state.” Last week, Gov. DeSantis announced a lawsuit against the FDA in response to its “unreasonable delay” in granting approval of the program.
2. FAHSC releases home visiting services RFP
The Florida Association of Healthy Start Coalitions has issued a request for proposals for a home visiting services provider, with the contract set to begin in late September. “The purpose of the initiative is to deliver coordinated home visiting services to identified high‐risk families, on a voluntary basis, in order to better equip parents and other caregivers with the knowledge, skills, and tools to assist their children in being healthy, safe, and ready to succeed in school,” states the RFP.
Grant funds for home visiting services could be as high as $623,533, according to the RFP. Eligible respondents, which may be nonprofit and for-profit organizations operating in Florida, include but are not limited to Healthy Start coalitions, hospitals, rural health networks, and federally-qualified health centers. The submission deadline for proposals is September 13th, 2022, with an anticipated contract start of Sept. 29th, 2022.
3. What They’re Watching: Melanie Brown-Woofter, FBHA
Melanie Brown-Woofter, CEO of the Florida Behavioral Health Association, says increasing access to care and supporting the integration of mental health, substance use services, and primary care are top priorities for her organization. In particular, she says she’d like to see the state utilize the Certified Community Behavioral Health Clinic model.
The goal of these clinics, Brown-Woofter says, is to strengthen care coordination for behavioral health and substance abuse services, which ultimately leads to better health outcomes and cost savings. “We see this as transformational, so that we can truly be a hub of community partnerships and provide the full continuum of care so that any individual who walks in or who Zooms in for a visit will have access to any service that they need.”
4. Florida hospitals lack price transparency, report finds
Over 100 Florida hospitals were found to be noncompliant with a federal price transparency rule nearly 18 months after it went into effect, according to a new report from PatientRightsAdvocate.org. Hospitals are deemed noncompliant by the report if they lack easily-accessible pricing criteria, such as a machine-readable charges file for items and services for all payers and plans, actual prices or a price estimator tool for common services, or incomplete data fields.
Interpretation of the federal price transparency rule has been contested. In a statement to State of Reform, the Florida Hospital Association stated that the report appears to misinterpret CMS guidance, which they say “significantly skew” the number of compliant hospitals. “Florida hospitals remain aligned with the CMS guidance on the hospital price transparency rule. Our hospitals will continue working collaboratively with CMS to ensure they stay compliant and ultimately help patients navigate the health care system,” FHA stated.
5. Ban on Medicaid coverage for gender-affirming care is now in effect
A rule banning Medicaid coverage for gender-affirming care went into effect at the end of August, following a June 2022 AHCA report which described this type of care as “experimental and investigational.” In response, the Florida Health Justice Project released a joint statement denouncing the rule, and Politico has reported that a coalition of transgender rights groups is preparing to sue the state to stop the ban.
A week after the ban went into effect, AHCA released data which indicated there had been a jump in the number of children receiving this type of care in recent years. The HRC then released a statement arguing that AHCA had used “misleading, cherry-picked data.” They also noted that gender-affirming care remains very rare among Medicaid enrolled youth.