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AHCA Levies Record Fine on Medicaid Health Plan for Delayed Payments

AHCA Levies Record Fine on Medicaid Health Plan for Delayed Payments


HCAF exists to provide representation, communication, and advocacy for Florida home care providers, and to give them the education and resources they need to deliver high-quality, cost-effective services to patients and clients at home. We welcome feedback from providers about any issues interfering with or hindering the effective delivery of care and the normal operation of business.

Providers across the state have been expressing their concerns regarding the Statewide Medicaid Managed Care (SMMC) health plans during the past several months, and your voices are being heard. It was announced yesterday that the Agency for Health Care Administration (AHCA) has fined the state's largest Medicaid health plan a record $9.1 million for delayed payments to providers. Along with the fine, Florida Medicaid also sanctioned Sunshine State Health Plan with a temporary enrollment ban until a series of corrective measures are in place. A similar announcement was made last fall when AHCA assessed $949,250 in fines against several health plans for a variety of infractions.

In order to raise and resolve such issues, HCAF regularly meets with AHCA officials and Medicaid health plan representatives, including Sunshine Health. Sunshine Health has been straightforward and open to discussing provider concerns in our interactions. In order to streamline feedback and analyze trends, we have developed the Home Health Agency Provider Complaint Form, a centralized online form to be used for state-level concerns (e.g., AHCA, Medicaid, health plans, etc.). If you prefer, you can contact a staff member directly. The form can be found under the Resources menu on our website.

As always, thank you for supporting HCAF!

P.S. In case you missed it, the U.S. Senate Special Committee on Aging held a particularly insightful and timely hearing yesterday to emphasize the importance of home- and community-based services (HCBS) for seniors and people with disabilities. Check it out here.

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