May
23
FABA is aware of notices that some providers have received from AHCA regarding termination of their service provider contracts. We understand how unsettling and disruptive this situation feels for business owners, their staff, and their clients. FABA will actively monitor this issue as it is essential that the children of Florida have access to quality care in a timely manner.
Additionally, FABA is aware that another health plan has announced their plans to reimburse at 80% of the published Medicaid rates. FABA knows how difficult it is to sustain high-quality ABA services when margins are tight, and we want to acknowledge the strain these cuts place on providers across the state.
Under the Statewide Medicaid Managed Care (SMMC) contracts, health plans are permitted to reimburse anywhere between 80% and 120% of the Medicaid fee schedule. Thus, this announcement of a revised reimbursement rate is fully allowable under their agreement with AHCA. Because the plans are operating within the terms of their state contract, there is no formal mechanism for FABA to challenge or appeal the rate selection.
Providers do, however, retain two options:
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Negotiate directly with the SMMC plan for a higher contracted rate. Some providers have had success when they demonstrate unique value, geographic need, or specialized services.
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Decline or choose not to renew the contract if the reimbursement level is not sustainable for their organization. While this is never an easy decision, it is within the provider’s rights.
FABA will continue to communicate with AHCA and the SMMC plans regarding the pressures providers are facing, and we remain committed to advocating policies that support sustainable access to care.
Please be sure to copy FABA on your AHCA and SMMC Health Plan complaints. Please do not include any Protected Health Information (PHI). Please be sure to reach out to FABA for any new or continuing concerns.
