Steven Grigas

Steven Grigas

Steven Grigas is a former interim Medicaid Director, Assistant Deputy Secretary, Deputy General Counsel, and Chief Medicaid Counsel for the State of Florida. In his various capacities, he has presided over the State’s $15 billion Medicaid program with particular focus in managed care, disease management, pharmacy services, long term care, and hospital services. Steven is knowledgeable in Medicaid policies and procedures, reimbursement issues, program integrity, and fraud control. Steven is also an accomplished litigator with experience in administrative, state, and federal courts.

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Uncertainty Surrounds Low Income Pool (LIP) Funding

The Centers for Medicare and Medicaid Services (CMS), in an August 3, 2017 letter to Florida’s Medicaid Director, approved a five-year extension of the State’s 1115 demonstration project, the Managed Medical Assistance Program (MMA). As part of this extension, CMS approved low-income pool (LIP) funding of approximately $1.5 billion annually. The LIP was created in 2005 to support hospitals, county … Continue Reading

Issues and Analysis of the State’s Medicaid Managed Assistance ITN

The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current ITN differs, however, should be of interest to all applicants and associated parties. This blog post addresses several of the more significant changes for consideration and may … Continue Reading

State Releases Medicaid Managed Care Invitation to Negotiate

Last Friday, July 14, 2017, the Florida Agency for Health Care Administration (AHCA) released its long awaited Invitation to Negotiate (ITN) for State Wide Medicaid Managed Care services. The ITN, one for each of the 11 regions within the state, may be found on the state Vendor Bid System (VBS), the link for which is provided here. This ITN … Continue Reading

HIPAA Audits – Phase 2: On-Site Audits Scheduled for First Quarter of 2017

Covered Entities and Business Associates may be ringing in the New Year with the prospect of responding to on-site HIPAA audits by federal regulators. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has announced that a certain number of comprehensive on-site HIPAA compliance reviews will be done over the first quarter of next year. Details … Continue Reading

Two-Midnight Rule Update

The Centers for Medicare and Medicaid Services (CMS) announced a further delay, through December 31, 2015, of the Recovery Auditors’ (RA) audits of the “Two-Midnight” Rule. Congress previously passed a law delaying enforcement Recovery Audits for the Two Midnight Rule through September 30, 2015. This has now been extended through December 31, 2015 with enforcement audits of suspect non-compliant … Continue Reading

King v. Burwell: An Answer Arrives

Thursday’s Supreme Court decision in the King v. Burwell case can be seen as a major victory for the Obama Administration, resolving, at least for the time being, the continued implementation of the Affordable Care Act by upholding insurance subsidies for about 6.4 million consumers in over 34 states. Once again, Chief Justice John Roberts, came to the rescue of … Continue Reading

Protests of the Medicaid Managed Assistance ITN Recommended Awards

Pursuant to Section 409.966, Florida Statutes, traditional Medicaid services are to be provided to Florida recipients through a limited number of Managed Care Organizations (“MCOs”) in the 11 Regions of the state.  The Agency released Invitations to Negotiate (“ITNs)” for each of the Regions inviting MCOs to submit proposals to provide coverage to Medicaid recipients in that Region.  The proposals … Continue Reading

OIG Recommends Florida make $2.3M Repayment for Medicaid Overpayment Reporting Failures

The Department of Health and Human Services (HHS), Office of the Inspector General, in a report dated March 2013, has recommended that the State of Florida repay approximately $2.3M in federal funds that represent the federal share of Medicaid overpayment collected for the audit period of July 1, 2007 through June 30, 2010, and a subsequent period of July 1, … Continue Reading

The Florida Agency for Health Care Administration Releases Questions and Answers Specific to the Medicaid Managed Care Invitations to Negotiate

Florida is in the process of moving the majority of its Medicaid population into managed care settings – either into Health Maintenance Organizations or Provider Service Networks.   First, Florida focused on moving long-term care Medicaid members – including Medicaid recipients in nursing homes and the Florida nursing home diversion program – into managed care. In January 2013, the Florida Agency … Continue Reading

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