The latest public policy updates affecting the Florida home care provider community include a recent court decision dismissing a lawsuit against the federal government over Medicare home health service shortages, insights from the latest edition of Florida Politics' health care policy newsletter, and new developments in the Florida Medicaid re-procurement process.

HCAF remains dedicated to advocating for our members and closely monitors legislation, regulations, and industry developments to keep you informed and prepared for changes in the home health landscape. For public policy inquiries, please contact Kyle Simon, Senior Director of Policy, Advocacy & Communications, at ksimon@homecarefla.org.

Court Dismisses Case Against HHS Secretary Over Medicare Home Health Service Shortages

A federal appeals court has dismissed a lawsuit brought by Medicare beneficiaries who claimed that the Secretary of the U.S. Department of Health and Human Services (HHS) was responsible for their inability to access adequate home health services. The plaintiffs, who suffer from chronic illnesses such as multiple sclerosis, argued that Medicare-certified home health agencies were refusing to provide the care they are entitled to under the Medicare program, forcing them to pay out of pocket for necessary services.

The case, Catherine Johnson, et al. v. Xavier Becerra, centered on allegations that the Secretary’s policies and enforcement practices were insufficient, leading to a widespread shortage of in-home care for Medicare beneficiaries. The plaintiffs sought a court order requiring systemic reforms to ensure better enforcement of Medicare regulations and to prevent what they described as discrimination against disabled individuals by home health agencies.

The U.S. Court of Appeals for the District of Columbia Circuit, however, rejected the plaintiffs' claims, ruling that they lacked the necessary legal standing to sue. In a decision issued on August 9, 2024, the court explained that the plaintiffs failed to demonstrate that their injuries were directly caused by the Secretary’s actions or that a court order against the Secretary would remedy their situation.

Circuit Judge Neomi Rao, writing for the court, noted that the plaintiffs’ grievances stemmed from the independent decisions of private home health agencies, which are not required to accept all Medicare patients. The court found that the plaintiffs did not provide sufficient evidence to show that changing the Secretary’s enforcement practices would lead these agencies to alter their behavior and provide the services sought by the plaintiffs.

The plaintiffs had argued that the Secretary’s lack of strict enforcement of Medicare regulations allowed agencies to underserve or refuse service to patients like them. They also claimed that the Secretary's policies contributed to the discriminatory practice of forcing disabled patients into institutionalized care rather than allowing them to remain at home with proper support.

Despite these arguments, the court concluded that it was purely speculative to assume that an injunction against the Secretary would prompt agencies to expand their services. The decision underscores the challenges faced by plaintiffs when seeking to hold government officials accountable for the actions of private entities.

With this ruling, the appeals court affirmed the lower court’s dismissal of the case, leaving the plaintiffs without the judicial relief they sought to secure better access to Medicare-covered home health services.

Diagnosis for 8.28.24: Checking the Pulse of Florida Health Care News and Policy

The latest edition of Diagnosis, a vertical from Florida Politics that examines the intersection of health care policy and politics, sheds light on a looming financial challenge for Florida’s health insurance program for state workers. The program is projected to face a staggering $1.5 billion deficit by 2029, driven primarily by escalating pharmaceutical costs and the recent veto of funding for college system employees.

In response to these financial pressures, Florida has successfully secured nearly $13.8 million in federal funds to bolster health coverage navigation, particularly for marginalized communities. This funding is a critical step toward mitigating the impact of rising costs. Additionally, the upcoming $2,000 out-of-pocket cap on Medicare prescription drugs, effective January 1, promises significant relief for seniors, highlighting efforts to protect vulnerable populations amidst broader fiscal concerns.

As the issue also marks the beginning of Suicide Prevention Month, it emphasizes the importance of addressing mental health crises and raising awareness across the state. Alongside these themes, the edition covers various regulatory updates and notable health care news, including a major financial dispute between Florida doctors and a leading Medicaid operator, underscoring the complex and evolving landscape of health care in Florida.

And Then There Was One: Managed Care Challenge Dropped

Sentara Care Alliance has formally withdrawn its challenge to the Florida Agency for Health Care Administration’s (AHCA) Medicaid managed care contract decisions. This withdrawal comes just prior to a scheduled hearing next week.

Administrative Law Judge Robert Cohen issued an order on August 27, 2024, closing Sentara’s case. Sentara filed a notice of voluntary dismissal on August 26 but did not disclose the reasons for its decision.

Following Sentara’s withdrawal, AmeriHealth Caritas Florida remains the only health plan contesting AHCA's contracting decisions. AmeriHealth Caritas was excluded from receiving a contract, and ImagineCare had also withdrawn its challenge earlier this month. A hearing regarding AmeriHealth Caritas is slated to commence next week.

In April, AHCA announced its intention to award contracts to five health plans and subsequently added three more in July. These multi-year contracts, which encompass approximately 3.1 million Medicaid beneficiaries, involve substantial financial commitments.

The Statewide Medicaid Managed Care (SMMC) system, established by legislators in 2011, requires most Medicaid beneficiaries to enroll in managed care plans. AHCA has conducted extensive contracting processes on three occasions, including the latest cycle that began in 2023 and concluded this spring. The current process has reduced the number of awarded contracts from 11 regions in previous years to nine.