In a case that involves hospitals spread across South Florida and the Tampa Bay area, an administrative law judge Tuesday began hearing arguments in a dispute about Medicaid payments for undocumented immigrants who need emergency care, reports Jim Saunders of the News Service of Florida.
The hospitals contend the state Agency for Health Care Administration in 2010 improperly placed new restrictions on paying for such emergency services, which has led to claims being denied and attempts to recoup money from hospitals.
Medicaid has long paid hospitals for emergency care provided to eligible undocumented immigrants, but the case centers on the extent of services that should be covered. The hospitals argue AHCA changed a key standard in 2010 without going through a formal rule-making process, as required by law.
But AHCA Assistant General Counsel Jeffries Duvall disputed that, saying the agency’s change was aimed at more-strictly enforcing limitations on Medicaid-funded care provided to undocumented immigrants.
“We don’t need a rule to enforce the law,” Duvall said. “The law is clear on its face.”
Joanne Erde, an attorney for the hospitals, argued that AHCA made an “abrupt” policy change that needed to go through a rule-making process, which can involve public meetings and input. The hospitals are asking Administrative Law Judge John D.C. Newton to order AHCA to stop using the 2010 change.
Documents and testimony Tuesday did not indicate how much money might be at stake for hospitals. But 18 hospital systems or individual hospitals filed the case, including the South Broward Hospital District, Lee Memorial Health System, hospitals in the Tenet Healthcare chain and hospitals in the BayCare Health System in the Tampa Bay area.
The case involves a somewhat-dense mixture of administrative law and details of the Medicaid system, such as how payments for services are authorized. Medicaid, a joint state and federal program that provides care to low-income people, does not pay for non-emergency hospital services for undocumented immigrants. That is not an issue in the case.
The crux, however, is a tougher payment standard that took effect in July 2010 for emergency care. Before that time, payments were made when emergency services were deemed “medically necessary.” But the more-restrictive standard involves paying for services until a patient is considered “stabilized.”
Beth Kidder, an AHCA assistant deputy secretary, testified Tuesday that the 2010 change stemmed from a federal audit that dealt with payments made for emergency care provided to undocumented immigrants. A document filed by AHCA in the case indicates it did follow-up audits that found “Medicaid had paid claims to hospitals for emergency (services) to undocumented aliens that did not comply with the Medicaid policy.”
But Diane Castro, a registered nurse who oversees getting Medicaid authorizations for patients at St. Joseph’s Hospital in Tampa, said the “stabilization” standard had not been used before. She said she took part in seminars from an AHCA contractor to try to get clarification about how the new standard would be used.
“It was a gray area and open to interpretation,” Castro testified.