Practitioners: Let's Go Ahead and Complain about Medicaid in Florida

Invitation to Take Action and Send in Concerns

FOTA representatives had a sit-down question-and-answer session with Florida Medicaid officials in March of 2018. I called in by phone. We had several questions about Medicaid policies regarding both pediatric and adult care issues. After all was said and done, the most striking comment we had to take away from our informative and respectful meeting was this:

“We just haven’t had many complaints about Occupational Therapy and Medicaid….you need to encourage your clients and practitioners to contact Medicaid to raise their concerns. When we have more complaints filed, we can look at our policies and consider what changes need to be made.”

As a board, we immediately took a vow to encourage OT practitioners and clients to become more deliberate about issuing complaints to AHCA regarding Medicaid through this online form:   or Recipient and Provider assistance by phone at 1-877-254-1055; Telecommunications device for the deaf (TDD) 1-866-467-4970.

 I encourage anyone, client or practitioner, to file your Medicaid complaint directly to AHCA. They need the numbers to be higher to address any potential changes.

Fast forward to May of this year and FLASHA- Florida Association of Speech-Language Pathologists and Audiologists, contacted me to join them in an effort to address issues with Medicaid in Florida for clients 0-21 years of age. FLASHA asked us to encourage FOTA members and all OTs in Florida to support the effort described below: from 

For many years now, Florida Medicaid therapy providers have been concerned with the practices of several third-party administrators including American Therapy Administrators of Florida (ATA/HN1), given their policies and practices are not in compliance with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program mandatesSee PDF Guide for States. We are also aware that in 2015, AHCA issued Corrective Action Plans to at least three MMA Managed Care Plans including: Amerigroup, Humana, and Sunshine for contracting with ATA/HN1 who was using a case rate model that could not ensure EPSDT. 

As a part of these Corrective Action Plans, there was to be an audit of ATA/HN1’s compliance with the EPSDT, notice of action, and continuity of care requirements by April 15 of 2015. 

Recently ATA distributed a document entitled “Enhanced Utilization Model for Physical Therapy, Speech, Therapy, and Occupational Therapy.”  We have reviewed this document along with email from an ATA/HN1 director regarding the new plan.  This new UM plan is to be implemented as of June 1st of 2018.  Given that this date is within a few weeks, we, as an association, have concerns about the new model and request that AHCA revisit the Corrective Action Plans written in 2015. 

There is ample reason for concern regarding the ATA capitated model and its impact on EPSDT. Florida Medicaid Therapy Providers contracted with ATA must abide by policies which place them in untenable positions .FLASHA prepared a formal position statement requesting that AHCA revisit the Corrective Action Plans written in 2015 and sent to those managed care companies utilizing ATA/HN1 (click to view). 


As President of the FOTA, I encourage our members to read this position statement provided through FLASHA. My call to action for Florida OTs: join FLASHA in endorsing this position statement and I recommend all OT professionals throughout the State of Florida to sign your name to this request by completing the form --see page at bottom. Our strength is in our numbers, and by joining together as FOTA and FLASHA,  we can help ensure that policies and practices remain in compliance wit h EPSDT mandates. We can continue to advocate for fair policies for reimbursement for valuable services provided to Medicaid clients across our state.

Brent Cheyne, OTD, OTR/L

FOTA President

[email protected] 









Share this post:

Comments on "Practitioners: Let's Go Ahead and Complain about Medicaid in Florida"

Comments 0-5 of 0

Please login to comment

Amazon searches starting from benefit FOTA!