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The Proposed Rule, if adopted, will cause significant negative consequences throughout
* 4 Medical Centers, with Level I and Level II Trauma Centers and 1 Statutory Teaching Facility
* Graduate Medical Education Program accredited by ACGME, which will include all 4 Medical Centers by 2022
* Memory Disorder Center and related Neurological Services
* Comprehensive Cancer Care
* 2 Federally Qualified Health Centers (since 1991)
* Joint Replacement Centers
* Specialized Cardiovascular Services
* Maternity Care and Level II and Level III NICU Units
* Liver Transplant Program
* Clinical Research and Grant Services.
Florida Specifics In Florida, local governments make substantial contributions to the State that help fund a variety of critical statewide health care initiatives for our residents, both permanent and transitory.
Specifically, local governments provide substantial funding for hospitals and outpatient centers to provide services that serve
Local contributions in
Over the last five years, these local contributions have helped to offset, but not fully cover, the cost of care for the poor and uninsured and to reduce the considerable gap between the cost of care and Medicaid payments. The contributions further serve to alleviate the projected physician shortage in the
We will briefly describe a few examples that will illustrate the potential severity of the Proposed Rule's impact on the health of our local communities and the patients that will be impacted.
This Proposed Rule Will Harm Patients and the Public Hospitals that Serve These Patients Under current law, local governmental entities, public health systems, and public hospitals can transfer public funds to their state Medicaid program to draw down a federal match (42 C.F.R. Sec. 433.51).
With some controls, the current system allows public funds--raised via local taxes and/or operating revenue--to be used and sent to the state or local Medicaid agency for use in the state's share of financial participation.
The Proposed Rule, if adopted, will serve to reduce or even eliminate the Medicaid funding currently used to address the health care of local communities. This, in turn, would reduce money currently used to help fund important health care initiatives designed to improve the health of communities and ultimately will require many local IGTs to be derived from increased taxes and/or increase the costs of health care in an effort to supplement the loss of funding. Alternatively, there would be a significant reduction in services to the most vulnerable individuals. This would undermine the purpose of the Medicaid program and the dictates of
Impact on Physician Access to
The Proposed Rule will end the State's wide-open access arrangement and jeopardize both the access and quality of care for all individuals.
The Proposed Rule Will Increase Administrative Workload and Decrease Transparency We support efforts to simplify and streamline Medicaid processes, to give states greater Medicaid flexibility, and to improve transparency and accountability at both the federal and state level. It is clear that CMS is considering the Proposed Rule because certain concerns around states use of provider donations, provider taxes, and tax waivers for Medicaid matching, particularly with respect to the concept of "hold harmless." While CMS's concerns and intentions are legitimate, the Proposed Rule will create more barriers to Medicaid, significantly increase the amount of federally-required paperwork and reviews, create vague (and therefore unpredictable) new standards, and unnecessarily restrict the mechanisms states and local governments can use to finance their Medicaid programs. Indeed, the Proposed Rule contains extensive new paperwork and review requirements. These include new annual reports that states must file regarding:
* Supplemental Payments (447.288(c)(2));
* Annual state reports on Federal Match (447.288(c)(3));
* Evaluations for Certain State Plan Amendments or Renewals (447.290); and
* New DSH Audit Reporting Requirements (447.299 and 455.301).
Additionally, the Proposed Rule creates a new requirement that certain state plan amendments must go through a renewal process every three years (447.252(d)) and also establishes a lengthy list of new information that must accompany any state plan amendment relating to a supplemental payment (447.252(d)).
Current federal law has limits regarding the provider tax rate that can be used to fund these desperately needed financing programs. CMS has been in control of this oversight for years. They approved many of these programs from other states that are now in question. Unfortunately, CMS has introduced rules that will harm those providers that legally abided by the rules that CMS approved and initiated. CMS should create clear legal definitions regarding what is permissible. If CMS cannot perform this function, then
Proposed Solution The current rule, which permits the use of these important and necessary public funds for Medicaid's state share, should remain in place. There is always room for improvement, but the Proposed Rule is not the solution. Rather, other options, which would alleviate CMS's concerns and reduce the impact on the public, involve a clarification from CMS that bona fide public health care entities may use their operating funds to utilize and support the federal match used to fund approved Medicaid services at the appropriate federal match rate. Likewise, CMS should use this opportunity to support the appropriate defmition of what constitutes a Publicly Qualified Entity (PQE) (i.e., it must be a nonprofit, have a governance structure that involves elected officials or persons appointed by elected officials, and it must operate in compliance with all federal, state, and local laws). This, along with other suggestions made by commentators, would provide transparency and reduce abuse and waste, but would not have the Proposed Rule's impact on the public because public entities will be permitted to use their operating revenues for federal matching funds in Conclusion We do not believe that CMS intended these consequences and we respectfully request that the Proposed Rule be withdrawn. We believe there are multiple avenues CMS could take that would not require local governments to raise taxes and would not impact access to health care, but would promote higher quality of health care and simplify the Medicaid program without compromising fiscal accountability.
Thank you in advance for your time and consideration. Should you have any questions, concerns, or would like to discuss these issues further, please do not hesitate to contact us at the number above.
President and Chief Executive Officer
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