TALLAHASSEE, Fla. – Outgoing Gov. Rick Scott’s administration has rejected an administrative law judge’s recommendation that the state should rebid Medicaid managed-care contracts in Southeast Florida for the treatment of people with HIV and AIDS.
Agency for Health Care Administration Secretary Justin Senior late last month issued a final order in a long-running dispute between the state and Positive Healthcare, a division of the AIDS Healthcare Foundation.
Positive Healthcare filed a legal challenge after the agency awarded Medicaid contracts to a competitor, Simply Healthcare Plans. Administrative Law Judge John Newton issued a recommended order in favor of Positive Healthcare, but, under state administrative law, the issue had to go back to the Agency for Health Administration for a final order.
Senior’s decision effectively overturned Newton’s recommended order, causing Positive Healthcare to quickly take the dispute to the 1st District Court of Appeal. The Tallahassee-based appeals court has agreed to temporarily stay Senior’s final order.
Positive Healthcare filed the underlying challenge after it was not chosen to participate in the Medicaid managed-care program in Broward, Miami Dade and Monroe counties. Instead, AHCA awarded the contracts to Simply Healthcare.
AHCA’s attorneys maintained that Positive Healthcare did not have legal standing to challenge the contracting decisions because Positive Healthcare violated a law that requires bidders to maintain a “cone of silence” during certain timeframes to prevent them from contacting state officials.
But Newton denied AHCA’s motion to dismiss the challenge, noting that the agency didn’t initially reject Positive Healthcare’s bid for a “cone of silence” violation and that the state had “simply changed its mind.”
In his final order, though, Senior wrote, “There is no factual dispute that Positive repeatedly contacted government officials for a contract award under the ITN (invitation to negotiate) during the time frame prohibited.” Senior also wrote that Positive Healthcare’s “counsel admitted Positive committed such a violation at hearing.”
Senior’s decision came as he prepares to leave his post as AHCA secretary and as Scott gives way to incoming Gov. Ron DeSantis. Senior is taking a position with the Safety Net Hospital Alliance of Florida, which represents public, children’s and teaching hospitals.
Florida lawmakers in 2011 required that almost all Medicaid beneficiaries enroll in managed-care plans, with contracts divvied up in 11 regions of the state. With an initial set of contracts expiring, the Agency for Health Care Administration went through a procurement process that included awarding the HIV and AIDS contracts to Simply Healthcare in two regions made up of Broward, Miami-Dade and Monroe counties.
While Senior rejected Newton’s recommended order on the HIV and AIDS contracts, he followed the judge’s recommendation on another issue. He said the state will negotiate Medicaid contracts with the South Florida Community Care Network for treatment of people with serious mental illness and people in the child-welfare program. The South Florida Community Care Network is a managed-care plan that operates as Community Care Plan. It is owned by the North and South Broward Hospital districts.