AIDS Healthcare Foundation Plans To Sue Florida Health Regulators Over Change In Medicaid Provider

By: Legal - Law News

The AIDS Healthcare Foundation is planning to file suit this week in Jacksonville, Fla., over a state plan that changes the provider of HIV/AIDS care for Medicaid beneficiaries in the state, Tom Myers, the organization's general counsel, said recently, the Florida Times-Union reports (Karkaria, Florida Times-Union, 6/14). AHF also has filed a contract bid protest with the state's Agency for Health Care Administration after losing its longtime Medicaid contract last month to the for-profit firm Specialty Disease Management Services.

AHF currently provides 70 disease-management nurses across the state. The foundation in its revised bid for the Medicaid contract proposed using 35 field nurses and at least 15 nurses at a call center. Steve Gutos -- a spokesperson for Jacksonville-based Specialty Disease Management -- would not comment on how many nurses his agency plans to employ. However, the Miami Herald obtained a copy of the firm's proposal to the state, which indicates that the agency plans to use up to 24 registered nurses and licensed practical nurses. Seven of those would be based at a Jacksonville call center, according to the document. Donna Stidham, a registered nurse and chief of managed care with AHF, said the state's plan under the new firm is not workable because HIV/AIDS patients require more personal monitoring, but Gutos said the comparison between the two plans is inaccurate. Officials with AHCA and Specialty Disease Management said the contract was awarded fairly. Agency spokesperson Doc Kokol said the state decreased the contract from $9 million to $4.5 million because many of the 8,000 Medicaid beneficiaries statewide receive care through other contractors in Broward and Duval counties (Kaiser Daily HIV/AIDS Report, 6/8).

Myers said AHF is seeking a court order to require AHCA to obey federal law and ensure that Medicaid beneficiaries in Duval and Broward counties receive quality medical care, the Times-Union reports. AHF as a health care provider legally can file suit for actions that directly affect it -- including payment delays or contract violations -- according to Lori Bilello, executive director of the Jacksonville-based Health Planning Council of North Florida. She added that it is unclear whether the suit would stand in court.

Myers said that the lawsuit is "not about who's providing care. The lawsuit is about the fact the care is not being provided." He added, "People are experiencing much less in terms of access (to) and quality (of) care. When you have HIV, if you don't get proper treatment ... you die." Fernando Senra -- a spokesperson for the Agency for Health Care Regulation, the state regulator -- would not comment on the planned lawsuit because the agency has not received it (Florida Times-Union, 6/14).

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