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Home My WebLink About2012-047 BOARD OF COUNTY COMMISSIONER` TRUECOPY CERTIFICATION ON LAST PAC K , BARTON , U. ERK 3 - 131 �V Wesley S. Davis Gary C. Wheeler C`� Chairman G� District I aV /a District 3 _ Joseph E. Flescher District 2 Peter D. O 'Bryan Vice Chairman ORI�p' District 4 Bob Solari District 5 March 12 , 2012 The Honorable Rick Scott State of Florida , The Capitol 400 South Monroe Street Tallahassee , FL 3239911110001 Dear Governor Scott : On March 9 , 2012 , the Florida Legislative Session passed HB 5301 , which addresses Medicaid billings from the Agencv for Healthcare Administration (ARCA) to the 67 counties . Indian River Countv is requesting that you veto this bill in an effort to maintain accountability in state government . Indian River County staff has serious concerns about this legislation as detailed below ; 1 . Since the launch of AHCA' s new computer system in 2008 , billings have been mired with problems . Over the past four years , bills have been consistently wrong with issues like incorrect address information , duplicative billings , and incorrect rates . These inconsistencies have resulted in a backlog of disputed bills and a lack of trust in the State ' s system . 2 . Rather than holding this State agency ( ARCA ) accountable for the incorrect billings of the past and present, the proposal absolves it of any accountability . It basically shifts this cost onto the counties with no real effort to provide accurate billings into the future . This is essentially an unfunded mandate on the counties in order to avoid requiring accountability and transparency of a State agency . 3 . Please note , billings from AHCA for October 2009 through August 2010 showed $ 0 Medicaid claims at Indian River Medical Center . It is impossible that an 11� month period passed where no Medicaid claims were incurred at the county' s largest hospital . This illustrates the level of errors in the AHCA billing system . Local staff contacted AHCA at the time to get this situation corrected and received no resolution . It seems that there was absolutely no quality control or review conducted by .ANCA for such a large 1801 27�h Street, Building A Vero Beach , FL 32960 (772) 2264490 A TRUE COPY CERTIFICATION ON LAST PAGE The Honorable Rick Scott J . K . BARTON , CLERK Page 2 of 2 March 12 , 2012 error to occur for such a long period of time . Based upon the data that we have received on this bill , apparently errors such as this were rampant throughout the State . These gross billing errors should be unacceptable to anyone at any level of State government . Simply telling the counties to pay the backlog without the ability to verify the data simply enables AHCA to continue performing at a similar level into the future . 4 . HB 5301 carries an estimated cost of over $ 1 . 4 million for Indian River County next year . Last fiscal year, our total costs were $ 863 , 443 . The Hospital District paid $ 205 , 978 , and the BCC paid $ 657 , 465 . The total increase of about $ 568 , 627 will result in a substantial increase for the County and the Hospital District . These expenses are supported by ad valorem taxes levied on county residents . Further, last fiscal year' s total cost was up from fiscal year 2009/ 10 ( $ 372 , 625 ) . This will be a 284% increase from the County' s Medicaid costs just two years ago . Please note , this is simply a cost- shift from the State to the counties and represents an unfunded mandate . 5 . Charging local governments before they can determine residency is an irresponsible use of taxpayer dollars . Counties have a fiduciary responsibility to their residents to ensure that the services they pay for are for services provided to the county' s residents . The proposed language makes each county pay first and then hope for a refund . 6 . The proposal would require counties to pay the billings up front in the future . Based upon past performance of ARCA, this concept is unsettling in that our county and others will invariably be billed for expenses that are not our responsibility . 7 . Disputed billings in the backlog should be certified by an independent 3rd party , NOT the agency responsible for the disputed billings . 8 . HB 5301 adds yet another layer of bureaucracy to a flawed system rather than fixing the problem . The current process includes the Department of Children and Families, the Agency for Healthcare Administration ( ANCA ) and 67 county governments — incorporating the Department of Revenue does nothing to solve the inefficiencies that already exist in the Medicaid billing system . As shown above , this legislation will have a significant adverse financial impact on Indian River County . We are asking for your assistance to veto House Bill 5301 . Thank you for all of your past and future efforts working to benefit the residents of Indian River County . If you would like to discuss this important topic further, please contact me at ( 772 ) 226- 1492 . Sincerely, Gary C .�eeler, Chairman , District 3 Indian River County Board of County Commissioners Medicaid County Billing and Payments FY 12- 13 Estimates Under Provisions of HB 5301 / SB 1988 Total Payments County Payments increase from FY 10-11 County Estimated FY 10-11 HB 5301 /SB1988 ALACHUA 61621 , 793 11253 , 744 51368, 049 BAKER 758 , 153 590, 485 167, 668 BAY 21494, 700 21106, 929 387, 771 BRADFORD 466 , 166 363, 742 1029424 BREVARD 7, 195, 935 41482, 377 21713 , 558 BROWARD 34 , 980 , 437 20 , 157, 365 14 , 823 , 072 CALHOUN 231 , 628 145 , 403 86 , 226 CHARLOTTE 10484 , 131 11025 , 084 459 , 047 CITRUS 11891 , 723 11418, 035 473 , 688 CLAY 11928 , 727 1 , 097 , 821 830 , 906 COLLIER 2, 678 , 165 2,694 , 342 ( 16 , 177) COLUMBIA 11196 , 875 746 , 280 450 , 596 DADE 72, 571 , 501 49 , 9710972 22, 5990529 DESOTO 449 , 614 310 , 778 138 , 836 DIXIE 2736104 1800562 92, 541 DUVAL 18, 1856561 9 , 6450062 8 , 540 , 499 ESCAMBIA 81034 , 514 2, 063 , 184 51971 , 330 FLAGLER 753 , 449 419 ,448 334 , 001 FRANKLIN 144 , 462 92,617 51 , 845 GADSDEN 774 , 051 324, 091 449 , 960 GILCHRIST 293 , 840 87 , 955 205 , 885 GLADES 91 , 131 875097 41035 GULF 282, 856 175 , 598 107 ,258 HAMILTON 204, 662 176 , 912 27, 749 HARDEE 606 , 330 284 , 038 322, 292 HENDRY 882 , 083 152, 376 729 , 707 HERNANDO 31218, 453 11405, 274 11813, 179 HIGHLANDS 1 ,475 , 625 949 , 847 525 , 778 HILLSBOROUGH 26 , 317 , 708 151465 , 471 10 , 852, 238 HOLMES 392 , 540 195 ,638 196 , 902 INDIAN RIVER CO 11233, 436 561 , 943 6711493 JACKSON 741 ,242 435 , 639 305,603 JEFFERSON 248 , 536 161 , 220 87, 317 LAFAYETTE 114, 101 103 , 002 11,099 LAKE 41315, 203 2, 311 , 729 21003, 473 LEE 71989, 370 51693, 295 21296, 075 LEON 21492, 011 11671 , 196 820 , 815 LEVY 921 , 601 399 , 728 521 , 873 ' +, a;� ' f1 LIBERTY 145 , 881 18, 606 127 , 275 MADISON 3037096 2816280 211817 `- MANATEE 419550916 31683, 863 1 , 272, 053 MARION 51797, 219 21713, 719 3 , 083, 501 - MARTIN 11350, 400 811 , 359 539, 041 � •, MONROE 11521 , 687 77, 777 1 ,443, 910 007' = NASSAU 838 ,403 419 , 009 419 , 393 :rA C OKALOOSA 11763 , 337 1 , 241 , 114 5221224 �`•tiO�j • . , Q OKEECHOBEE 688 , 369 319 , 815 368 , 555 `•.• * • , , , , ' ��\P?,. . ORANGE 31 ,649 , 741 16 , 855 , 681 141794 , 060 •�••"+ ••• •�• `r' OSCEOLA 61062, 355 21931 , 499 311301856 PALM BEACH 191402,035 11 ,427 , 882 71974, 153 PASCO 61279 , 437 31522, 107 21757, 329 �� PINELLAS 24, 326 ,720 12,059 , 995 121266 , 724 POLK 12, 235, 120 61110, 719 61124 , 401 PUTNAM 11681 , 861 842 , 085 8390776 :n SANTA ROSA 9070856 983 , 255 (75 , 398) SARASOTA 5, 080, 672 3 , 147, 612 1 , 933, 060 ?= SEMINOLE 21267, 103 31373, 124 ( 1 , 106 , 021 ) L C _ ST JOHNS 319680481 579 , 113 31389, 368 hi ST LUCIE 61708 , 382 933 , 854 56774, 529 Lu Q ? SUMTER 705, 981 240 , 864 465 , 117 « ¢UJ SUWANNEE 1 , 000, 724 560, 115 440 , 608 � a`! Cljr 0 �I TAYLOR COUNTY 382,641 236 , 619 146 , 023 c : to -' t UNION 236 , 021 341 , 737 ( 105 , 715) LL > a iu VOLUSIA 71836, 200 41870, 338 21965, 863 $ c F ¢ c7 LL WAKULLA 240 , 081 145 ,771 94, 309u� z rn w ¢ U F: Q = p0 WALTON 4391573 144 , 909 294 , 665 � o as ¢ U u, r j WASHINGTON 460, 835 316 , 653 144 , 182 .z < < nowco STATE TOTALS 364,351 ,298 208 , 597 ,751 155,573 ,796 -- Current Law Estimate 28618151240 Net Changes 77,536 ,058 1111 3/2/2012 HB 5301 & SB 1988 County Estimates SFY 12-13.xlsx