PO Box 4411, Cary, NC 27519-4411
www.fahcs.us - [email protected]
March 10, 2016
Jeff Atwater
Chief Financial Officer
Florida Department of Financial Services
200 East Gaines Street
Tallahassee, FL 32399
Via Email: [email protected]
Pam Bondi
Attorney General
State of Florida
The Capitol PL-01
Tallahassee, FL 32399-1050
Via Email: [email protected]
Elizabeth Dudek
Secretary
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, FL 32308
Via Email: [email protected]
Kevin M. McCarty
Florida Insurance Commissioner
400 East Gaines Street
Tallahassee, FL 32399
Re:
Via Email: [email protected]
Request for Moratorium to be Placed on Third Party Administrator Licensure
Dear Mr. Atwater, Ms. Bondi, Ms. Dudek, and Mr. McCarty:
On behalf of the American Association of Homecare (AAHomecare), the Home Care Association of Florida (HCAF), the
Florida Alliance of Home Care Services (FAHCS) and durable medical equipment companies and other health care providers
(collectively referred to as “Providers”) that are required to work with Third Party Administrators (“TPAs”), we request that the
Agency for Healthcare Administration (“AHCA”) and Office of Insurance Regulation (“OIR”) place an immediate moratorium on
current, pending and future TPA applications for licensure.
This moratorium is requested in order to avoid another “Univita Like TPA” from forming and operating without regulatory
oversight. The moratorium will allow the appropriate state agency to develop oversight requirements to ensure that TPAs comply
with established standards of practice. In doing so, patient care will be assured and another Univita type of fiasco will be avoided.
There are hundreds of Providers and thousands of patients still suffering from the Univita meltdown. The Providers are left
fighting for millions of dollars owed in receivables; they need assurance this will never happen again. The thousands of patients who
have been transferred to another Provider, or are still without a Provider, or went without needed services during the collapse of Univita, continue to suffer. Following the Univita collapse, Providers were left scrambling to provide patient services without compensation. A moratorium will provide the time necessary to implement safeguards to avoid another Univita type of collapse.
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We request that the moratorium include the following:
General oversight of operations to assure fair use of contracted Providers
Contracting parameters to ensure that “any willing provider” protections are afforded by the TPA
Prohibition against a TPA having direct or indirect ownership in a licensed Provider
Reimbursement guidelines that, at a minimum, calculate reimbursement as a percentage of Medicare & Medicaid fee schedules
Maximum charges for TPA services
Oversight of payment terms and denial ratios
Requirement that the TPA post a surety bond to assure, at a minimum, partial payment in the event of dissolution
Florida Alliance of Home Care Services
By:
Beth Bowen, Executive Director, FAHCS
Home Care Association of Florida (HCAF)
By:
Bobby Lolley, Executive Director, HCAF
American Association for Homecare
By:
Thomas Ryan, President and CEO, AAHomecare
c:
Senator Rene Garcia – via email
Senator Aaron Bean – via email
Representative Jason Brodeur – via email
Representative Matt Hudson – via email