Medicaid Medical Managed Care (MMA) –Intro to Reform
My group of Speech-Language Pathologists (SLPs) are a pretty flexible bunch. We adjust our schedules to accommodate whatever comes up in the lives of our young clients and their families every day. We adapt our materials and methods to the children’s natural environments, individual learning styles, frequent communication partners and preferred incentives or rewards.
If, as a result of Medicaid reform, we find ourselves in a situation where our professional services are no longer viable in the state of Florida, I think resilience will prevail. Many of us may simply move to a different state. According to a bulletin sent by the Florida Association of Speech-Language Pathologists and Audiologists (FLASHA), concerning reimbursement rates for OT/PT/ST services in Florida:
“A recent study conducted by the Alliance for Pediatric Therapies, based on a public records request to AHCA, revealed…. Florida ranks significantly lower than the other southeastern states, concerning reimbursement of OT/PT/ST services.” The Medicaid reimbursement rates paid in several other states for a 4-unit (60-minute) therapy session were listed. Personally, I’ve got Georgia on my mind!
More troubling information was provided in this bulletin:
“A recent survey comprised of 12% Florida OT/PT/ST therapy service providers in over 20 counties was conducted by the Alliance for Pediatric Therapies to poll providers’ satisfaction with the Medicaid program. Results yielded the following:
- 47% have decreased or discontinued services to this population, citing increased administrative burden and/or lack of rate increase;
- 60% reported they were likely or somewhat likely to stop providing services to the Medicaid population;
- 41% reported administrative functions required for service to this population consume 25% or more of reimbursement;
- 75% reported the current level of administrative burden affects their ability to provide quality of care to this population.”
This survey was conducted prior to the statewide rollout of the MMA program, which will commence in several upstate counties on May 1, 2014. Things are about to take a turn for the worse…
With privatization of the state plan imminent, and Medipass scheduled to be discontinued in Miami-Dade County as of July 1, 2014, it is finally beginning to become apparent that our most vulnerable population of children with special needs–Medicaid recipients–are in danger of losing medically necessary therapy services. Contracts being sent to therapy providers, from representatives for the private insurance companies, are extremely restrictive and highly incompatible with current guidelines for service provision (as per the AHCA Florida Medicaid provider handbooks). In my opinion, this will surely have an adverse and immediate effect on pediatric therapy service provision in the private sector.