Unveiling the Mystery: Health Care Transparency Explained
TL/DR –
Florida Governor Ron DeSantis vetoed a $750,000 item in the state’s Agency for Health Care Administration’s budget aimed at procuring an independent study to evaluate the utility of collected health care data. The study was set to include a review of costs incurred over the last three state fiscal years and current development efforts. Additionally, DeSantis vetoed a $1 million item from the agency’s budget intended for an assessment of payment transactions in the Medicaid program for medical benefit and administrative costs as part of the Achieved Savings Rebate (ASR) Program.
Florida Health Care Investment: Price Transparency and Vetoed Studies
Florida has dedicated significant funds to bolster health care price transparency. Yet, Gov. Ron DeSantis vetoed a $750,000 provision in the state Agency for Health Care Administration’s budget, intended for an independent study of the data collected.
The Legislature required this study to encompass all costs associated with these tools over the past three state fiscal years. It also needed to assess ongoing development and redesign efforts, including contract compliance.
A range of requirements was stipulated for the study, which was to evaluate the state’s claims database and its relation to the health insurance market. The study was meant to analyze how the collected data influences health care decision-making for consumers, the public sector, employers, and researchers.
The Agency for Health Care Administration (AHCA) was instructed to submit the study to key Senate and House committees, as well as the Governor’s Office of Policy and Budget by the end of the year.
Gov. DeSantis also vetoed an additional $1 million from the AHCA’s budget intended for an assessment of payment transactions in the Medicaid program. This was related to the Achieved Savings Rebate (ASR) Program’s medical benefit and administrative costs for 2020, 2021, and 2022.
The ASR program, part of the statewide Medicaid managed care program, is designed to prevent these care plans from earning excessive profits. It establishes pre-tax income as a percentage of revenues. Under Florida law, the plan retains all profits up to 5% of revenue. Profits above 5% and up to 10% of revenue are shared equally between the plan and the state, while all profit above 10% is refunded to the state.
Plans can retain an extra 1% of revenue if they meet or exceed quality measures defined by the AHCA. These include plan performance for managing complex, chronic conditions associated with high-cost medical treatments.
The vetoed budget provision would have necessitated the study to include a comparison of payments to Medicaid managed care plans within the medical loss ratio, relative to the standard health care procedure code level for other Medicaid providers.
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