In this month’s edition of “5 Things We’re Watching,” we have a look at key takeaways from the SMMC reprocurement RFI, a Q&A with InnovAge’s Carol Steckel, and details on Florida health agencies’ efforts to address fentanyl-related overdoses.
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State of Reform
1. Advocates urge Congress to close abortion coverage gap
Following the Supreme Court’s overturning of Roe v. Wade, reproductive rights advocates are urging Senate Democrats and the Biden administration to close the abortion coverage gap for vulnerable Floridians. They argue that the overturning of federal abortion protections, combined with Florida’s lack of Medicaid expansion, is creating a coverage gap that will disproportionately impact communities of color and increase maternal mortality rates.
“Losing access to legal abortions is likely to mean higher maternal morbidity and mortality rates, driving up health disparities,” said State Rep. Angie Nixon during a recent press conference hosted by Health Care for Florida. “Non-expansion states like Florida are moving to restrict legal abortions the most. Pregnancy can be a death sentence for some women, particularly Black women, who are at a 4 times greater risk of experiencing maternal mortality.” Of the 425,000 Floridians who fall into the Medicaid coverage gap, about 170,000 are women of reproductive age.
2. Key takeaways from SMMC reprocurement RFI
Nearly 60 Florida health plans, provider groups, and community organizations provided recommendations to the Agency of Health Care Administration (AHCA) ahead of the reprocurement process for Statewide Medicaid Managed Care (SMMC), scheduled for this fall. The request for information AHCA issued earlier this year aimed to gather information “regarding best practices and innovations in business models as well as service delivery for Medicaid managed care,” according to the document.
Key focus areas among respondents include addressing social determinants of health, improving the Medicaid provider experience, and improving home and community-based services. For example, Aetna Better Health of Florida wrote in their response that a wider range of community providers in the Medicaid program can “complement a comprehensive, culturally sensitive, system of care approach—resulting in enhanced quality outcomes that empower the recipient in management of care and reduce overall program costs.”
3. What They’re Watching: Carol Steckel, InnovAge
Carol Steckel has 30 years of experience working with the Program of All-inclusive Care for the Elderly (PACE), and is the Executive Vice President of Government Relations at InnovAge. In this “What They’re Watching” video, Steckel reflects on the transformation of PACE from small-scale, community-based models to state investments that are being replicated across the country.
Steckel says providing a one-stop shop for primary care and community supports helps relieve hardships for both participants and their caregivers. “We have an interdisciplinary team that’s made of 11 different professions and we’re always helping not only the participant, but the caregivers, with coordinating that care,” she says.
4. State agencies collaborate to address overdoses
Florida state agencies—including DOH, DCF, and FDLE—are collaborating to address rising overdoses and deaths associated with fentanyl. Following a national upward trend of overdose-related deaths, over 6,150 Floridians died from overdoses involving fentanyl in 2020, according to data from FDLE’s Medical Examiners Commission.
In a recent safety alert, DOH highlighted several resources for those struggling with substance use including Hope for Healing, which aggregates federal, state, local, private sector, faith-based, and nonprofit resources, and Hope Florida – A Pathway to Prosperity, where care navigators work to develop a unique care plan for individuals in need. They also highlighted the HEROS program, which provides free naloxone to emergency response agencies.
5. Updating Medicare’s physician fees is a challenge again
Congress and CMS have struggled for decades to establish a stable and affordable system of determining annual updates for physician fees. That’s the subject of State of Reform Columnist Jim Capretta’s latest piece, which dives into the history of the issue and discusses the opposition that is now building in the physician community to CMS’ proposed payment adjustments for 2023.
Capretta says recent updates to physician fees have resulted in real reductions in payments. But he also notes that permanently undoing these real reductions would increase long-term Medicare spending and drive up premiums for beneficiaries. He writes: “Given the many challenges involved, the most likely path forward is the one that Congress has been on for some time: annual ad hoc adjustments to address immediate pressures without any clear plan for finding, much less implementing, a more enduring solution.”