Outgoing Administration Rejects Judge's Ruling on HIV Contracts
The Agency for Health Care Administration 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.
January 07, 2019 at 12:32 PM
3 minute read
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.
The Agency for Health Care Administration 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 AHCA for a final order.
The AHCA decision effectively overturned Newton's recommended order, causing Positive Healthcare to quickly take the dispute to the First District Court of Appeal. The Tallahassee-based appeals court has agreed to temporarily stay the agency'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 time frames 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.”
The final order, though, said, “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.” The order also said Positive Healthcare's “counsel admitted Positive committed such a violation at hearing.”
AIDS Healthcare Foundation President Michael Weinstein said the group has tried to reach a settlement with the Scott administration but has been unsuccessful.
In a statement to The News Service of Florida, Weinstein said he's hopeful that the new administration will try to settle the dispute.
“With a new administration and completely new players, we are ready at any time to sit down to resolve this dispute,” he said. “In the meantime, as the largest AIDS organization in the nation and Florida, we will do what we do best — serve our clients.”
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 AHCA 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 AHCA rejected Newton's recommended order on the HIV and AIDS contracts, it followed the judge's recommendation on another issue. 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 SFCCN is a managed-care plan that operates as Community Care Plan. It is owned by the North and South Broward Hospital districts.
Christine Sexton reports for the News Service of Florida.
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