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Competitive Bidding Arises in Florida Budget: Florida's Medicaid agency, the Agency for Health Care Administration, has a budget calling for a pilot program to test DME capitative competitive bidding. The proviso language requires “that we do a competitive procurement for a demonstration capitated DME program,” said Connie Ruggles, a senior management analyst at AHCA's Medicaid office.
Although the program's structure has yet to be determined, the agency's request for proposal will be for organizations interested in bidding as a contractor for the plan. The selected company will receive a per member, per month fee to provide all DME services for Medicaid recipients in a “demonstration” geographic area yet to be determined. The capitated rate will be no more than 80 percent of the current Medicaid fee for service per member per month.
The proviso excludes customized wheelchairs, prosthetics, ostomy and colostomy supplies. Such items will continue to be paid on a fee-for-service basis.
Outside these exclusions, the selected company would have to “provide quality service to everyone that gets DME service [in the area] and they have to do it at a 20 percent savings,” Ruggles explained. The state plans to implement the program in early 2004.
Earlier this year, a lawsuit filed by the Florida Association of Medical Equipment Services successfully blocked the AHCA from implementing statewide competitive bidding for hospital beds and respiratory equipment and services.
“After we won our lawsuit, this is what they come back with. We're getting together with the parties that will be affected” to discuss options, said Joan Cross, president of FAMES and C&C Homecare in Bradenton, Fla.
