Stakeholders pound pavement in Florida

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Monday, March 30, 2020

TALAHASSEE, Fla. – The state of managed care in Florida motivated Sylvia Toscano, a long-time industry consultant, to visit the state capitol for the first time in January.

“To see these unhealthy patterns happening with MCOs and TPAs in the state has been upsetting,” said Toscano, who was part of a group of more than a dozen members of the Florida Alliance of Home Care Services (FAHCS) to make the trip. “I’m seeing small providers just shutting down because of it. That’s what got me involved.”

Here’s what Toscano, who is a board member of FAHCS and the president of Pro-Med DME Billing/Consulting in Boca Raton, Fla., had to say about why stakeholders in the state are as active as they’ve ever been.

HME News: How did your visits with legislators go?

Sylvia Toscano: What was interesting to me is that the newer legislators were unaware of the managed care history in Florida, specifically what happened in 2015 with Univita (which went bankrupt). None of them knew about the collapse of the DME industry in the state. We felt they had to know about that because if that were to occur again, it would be devastating.

HME: What is happening right now with managed care in Florida?

Toscano: Almost all of the state is managed care and we’re seeing a big migration to TPAs. These TPAs are privately owned and they’re managing the referral relationships, and they also have subcontractors—it’s the same business model as Univita.

HME: What was your “ask” in your
meetings?

Toscano: We need better oversight of the TPAs by the Agency for Health Care Administration. We also leaned on legislation sought in other states to ask for things like requiring MCOs to reimburse DME providers at 100% of the rate set by Florida Medicaid.

HME: What was the response?

Toscano: One of the legislators we met with is a local representative in my area. She’s newly on the health care reform committee. She told us how she is the sole provider of her grandmother, who was recently placed on oxygen and put in a wheelchair. She had no clue what home medical equipment was before this. So this really struck home with her.

HME: It’s not FAHCS’s first trip to
Tallahassee.

Toscano: No, but it’s my understanding that this was one of the most organized trips. Our lobbyist made arrangements for a lot of meetings. Members of the board say FAHCS is the strongest it’s ever been. It has made great strides and it wants to accomplish more. hme