Judge Recommends Florida Health Regulators Reconsider Change in Medicaid Provider

An administrative law judge in Florida recently recommended that the state's Agency for Health Care Administration reconsider a state plan that changes the provider of HIV/AIDS care for Medicaid beneficiaries in the state, the Florida Times-Union reports (Karkaria, Florida Times-Union, 9/6). The AIDS Healthcare Foundation in June filed a lawsuit in Jacksonville, Fla., over the plan. AHF also filed a contract bid protest with the state's AHCA after losing its longtime Medicaid contract in May to the for-profit firm Specialty Disease Management Services.

AHF currently provides 70 disease-management nurses across the state. The foundation in its revised bid for the Medicaid contract proposed using 35 field nurses and at least 15 nurses at a call center. Steve Gutos -- a spokesperson for Jacksonville-based SDM -- would not comment on how many nurses his agency plans to employ. However, the Miami Herald obtained a copy of the firm's proposal to the state, which indicates that the agency plans to use up to 24 registered nurses and licensed practical nurses. Seven of those would be based at a Jacksonville call center, according to the document. Donna Stidham, a registered nurse and chief of managed care with AHF, said the state's plan under the new firm is not workable because HIV/AIDS patients require more personal monitoring, but Gutos said the comparison between the two plans is inaccurate. Officials with AHCA and SDM said the contract was awarded fairly. Agency spokesperson Doc Kokol said the state decreased the contract from $9 million to $4.5 million because many of the 8,000 Medicaid beneficiaries statewide receive care through other contractors in Broward and Duval counties.

Tom Myers, AHF's general counsel, said the organization is seeking a court order to require AHCA to obey federal law and ensure that Medicaid beneficiaries in Duval and Broward counties receive quality medical care. AHF as a health care provider legally can file suit for actions that directly affect it -- including payment delays or contract violations -- according to Lori Bilello, executive director of the Jacksonville-based Health Planning Council of North Florida (Kaiser Daily HIV/AIDS Report, 6/15).

The judge, who recommended that the two-year Medicaid contract be rebid, ruled that the proposal from SDM be rejected because the state's Agency for Health Care Regulation does not have sufficient information to determine if the company has the financial ability to execute the contract. The judge also ruled that AHF's proposal be rejected because documents involving accreditation were not submitted and because AHF's cost estimates could exceed the limits established by the contract. AHCA and SDM officials could not be reached for comment, the Times-Union reports.

AHF officials said they plan to rebid for the contract. "Now, the slate is clean and we go forward from this point," AHF President Michael Weinstein said at a news conference. He added, "We have the lives of 8,000 people to be concerned about. This is an extremely vulnerable population not only because they suffer from a life-threatening illness, but also because they suffer from poverty and a variety of other challenges." According to Weinstein, the judge's issues with AHF are "technical" in nature and do not "relate either to [AHF's] financial viability or the quality of care" that AHF provides. AHF will continue to provide services to HIV-positive Medicaid beneficiaries through at least the end of the year (Florida Times-Union, 9/6).