History: 

-        2011, the Florida Legislature created a new program called the Statewide Medicaid Managed Care (SMMC) program that included The Long-Term Care (LTC) Managed Care Program. 

-        Each managed care plan contracted with AHCA to provide an array of long-term care services that include ADH Services. Plans contract with providers to provide long-term care services. Many providers are on a fee schedule, except for Adult Day Health, whereby Rates are negotiated between plan and providers with no guidelines from AHCA or avenues of appeal for providers to assure that the rates negotiated reflect actual costs for providing services.

-        As a result, Contracted rates have varied significantly from provider to provider and from plan to plan. Such rate disparities that can lead to providers/plans focusing on rates, not the quality of services.

-        Since the program's launch back in 2013, Health Plans have received an average of 30% increase, however, the providers have not received any such benefit. ( Based on historical data provided by AHCA)  https://ahca.myflorida.com/medicaid/Finance/data_analytics/actuarial/index.shtml

-        For the most part, rates have remained the same for over a decade—no increases from plans to providers since initial contracting.

-        Funding issues magnified over the last year secondary to Florida Medicaid Provider Minimum Wage. Minimum wage increased (75.23% from 2021 to 2022).

-        Increased cost secondary to  Covid19 Pandemic, drastic Cost of Living increase (U.S. inflation March 2022: Consumer price index jumped 8.5%, highest spike since 1981) and Labor Shortages secondary to other industries offering higher starting wages.   https://www.bls.gov/news.release/pdf/cpi.pdf

-        Many providers have tried negotiating rates with plans with no success or insignificant increases. Under the current conditions, the providers have no leverage to negotiate fair rates.