Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
The final countdown is here. Legislators have just two weeks left to wrap all their work from the 2022 session, meaning it’s going to be a hectic race to the finish. Most committees are done for the year, and if a bill isn’t ready to go to the House or Senate floor, it is likely dead.
One checked-off item was the confirmation vote this past week of State Surgeon General Joseph Ladapo. Democrats sharply criticized Ladapo as a “yes man” for Gov. Ron DeSantis and assailed the Harvard-trained doctor over his skepticism over vaccines and masks. But the Republican majority stood by the Governor’s contentious nominee and delivered a win for the Governor.
But let’s take a peek at some of the Governor’s other health care priorities and where they are with the clock ticking down.
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— BUDGET BLUES? —
Let’s start with the budget, which will have the heavy lifting next week. The House and Senate expect to finally commence formal budget negotiations in the next few days with a hard deadline looming. Thanks to Florida’s 72-hour “cooling off” period, lawmakers much finish the budget by March 8 to end the Session on time.
Legislators haven’t yet embraced some of DeSantis’ critical budget recommendations made before Session, including a $1 billion gas tax moratorium or the second round of $1,000 bonuses to first responders. It’s been the same story with some of his health care budget recommendations.
The Governor, for example, recommended that the Legislature continue to provide $300 million in recurring dollars to hospitals that offer the most amount of Medicaid care in the state. House and Senate budget writers did not heed the call, but top DeSantis administration officials supported the request. Agency for Health Care Administration Secretary Simone Marstiller met this past week with hospital CEOs to reinforce their support.
Other remaining items include increased funding for cancer research care — a priority for First Lady Casey DeSantis — which also hasn’t made it into the budget. DeSantis also asked for a $10 million boost in spending on Alzheimer’s research, which was not matched in the House and Senate budgets.
To be clear, other spending priorities made it into the initial budgets, including money for the still on-hold Canadian drug importation program. The Senate has gone along with a proposed $20 million increase in mental health initiatives in public schools, but the House did not pick up that recommendation.
— SPEECHLESS —
DeSantis this Session also threw his support behind bills to prevent the Department of Health from cracking down on doctors accused of spreading misinformation about COVID-19. He even posted on his Twitter account earlier this month that “physicians in Florida should be able to practice. medicine and express opinions without facing sanctions simply because they are not parroting the prevailing ‘narrative.’”
But as of right now, it appears that the bills that the Governor touted are unlikely to make it across the finish line. SB 1184 is not on the final bill agenda the Senate Appropriations Committee will consider this week. Likewise, HB 687, its counterpart, is not on the final schedule of bills that the Health & Human Services Committee is considering.
The bills were proposed after regulators started to scrutinize information being posted about COVID-19 by physicians and other health care professionals.
House bill sponsor Rep. Brad Drake said he filed the bill after hearing about physician Joel Rudman. Rudman testified in committee that the American Board of Family Medicine tried to act against him after making comments about the COVID-19 vaccine. A complaint was also filed with the Department of Health against State Surgeon General Ladapo, but it was never pursued.
The House Professions and Public Health Subcommittee advanced the bill after deleting a $1.5 million fine the Department of Health could face if it violated a practitioner’s right to free speech. But the legislation — which organized medicine groups do not support — has stalled.
— MEDICAID MESS? —
Still up in the air: Can the Florida Legislature come together and give the Agency for Health Care Administration the statutory changes it says are necessary to help ensure the third round of securing major contracts to run the mammoth health care safety net program runs smoothly?
On Monday, the Senate Appropriations Committee will consider its version of the Medicaid managed care rewrite, SB 1950. Bill sponsor Sen. Jason Brodeur has filed four amendments to his bill that tweak the Medicaid managed care regions and the number of health plans in each region that can be awarded multiyear Medicaid contracts worth tens of billions of dollars.
The amendments have the cumulative effect of halting the proposed merger of Medicaid Regions 5 and 6 into a larger area and changing the number of Medicaid-managed medical assistance and Medicaid long-term care plans the state can contract within those areas. Brodeur’s amendment would also increase the number of MMA and LTC plans that could be contracted within Region 5, upping it from the four-plan maximum to a six-plan maximum. Conversely, Brodeur’s amendment decreases the maximum number of plans contracted from a maximum of seven plans to a maximum of four.
Brodeur hinted a week ago that the Senate might not keep to the eight regions that AHCA had initially proposed. Brodeur’s move to change the number of districts adds to the number of differences between the House and Senate managed care bills. While the House last week backed off its push to require MMA and LTC plans to provide dental services, the House continues a push to require all “essential” hospital providers to contract with every Medicaid-managed care plan in the state.
— FLORIDA FREEDOM —
It’s being called the “No Patient Left Alone Act.” On Monday, the Senate Appropriations Committee will take up SB 988 but tack on an amendment that rewrites the bill to eliminate the potential workload increase for AHCA.
The bill currently requires hospitals, nursing homes, ICFDDs, group homes, assisted living facilities, and other institutional providers to adhere to statewide visitation rules (which have yet to be developed.) Providers are authorized to establish alternate visitation protocols if there is a health or safety concern. The alternate visitation protocols must be submitted to the state annually for approval. AHCA is required under the terms of the bill to dedicate a webpage to explaining visitation rights and provide a method for individuals to report to AHCA any alleged violations of the rights.
The bill means to address disparate visitation policies across Florida’s health care sector. While the federal government has guidelines that impact facilities that receive Medicare and Medicaid funding, other providers, such as ALFs, are not federally regulated and operate solely under a license issued by the state.
AHCA estimated that 16,816 licensed entities that serve clients would be required to develop alternative visitation policies. AHCA would also need an additional 43 employees, including six senior attorneys, to review and approve the guidelines, inspect providers for violations and prosecute complaints. AHCA estimated that there could be as many as 2,500 visitation complaints against providers annually.
An amendment to the bill requires long-term care providers and hospitals and hospices to establish visitation policies that address infection control and prevention. The bill clarifies that the visitation policies cannot require visitors to submit proof of any vaccination or immunization and must allow visitors to physically touch the patient unless the patient objects.
The policies must be submitted to the state during the initial licensure process and licensure renewals. The procedures must be developed within a month of the bill being signed into law. Moreover, once developed the policies must be posted on the providers’ homepages within 24 hours.
The House is taking up its version of the bill, HB 987, Monday in the Health & Human Services Committee. The amendment is similar but not identical to what the Senate is considering.
— ROSTER —
The Senate Ethics and Elections Committee is recommending the following gubernatorial appointments be confirmed by the Senate:
Tinerfe J. Tejera to the Board of Dentistry
Dean Easterwood and Randy M. Ellsworth to the Board of Hearing Aid Specialists
Maria D. Garcia to the Board of Medicine
William Kirsh to the Board of Osteopathic Medicine
Yvonne Schloss and Irene J Stavros to the Board of Opticianry
Mark S. Block and Soorena Sadri, to the Board of Podiatric Medicine
Amy Cruz, MSN was appointed the Chief of the Office of High Reliability for the North Florida/South Georgia Veterans Health System.
Rafael Bustamante, MD, will lead vascular surgery at HCA Florida University Hospital in Davie and Westside Regional Medical Center in Plantation.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
Been there, done that A bill that would establish standards for certified peer specialists and allow them to be part of the state’s alcohol and drug abuse delivery system is on its way to the Governor after the House passed the bill 114-0 last week. SB 282 amends state law to label certified peer specialists as an essential part of a coordinated system of care to treat substance use disorder. Peer specialists are persons who have recovered from substance use disorder (SUD) or mental illness who support a person with a current substance use disorder or mental illness.
No butts on beaches The House, for the first time, passed a bill that would allow local governments to ban smoking on beaches. HB 105 would allow cities and counties to regulate the smoking of cigarettes in government-owned parks. Many cities and counties have tried to ban smoking on beaches in the past, but a ruling in a 2017 case brought by the ACLU against a Sarasota ban on smoking in parks made clear no local ordinance could regulate outdoor smoking.
Furry friends’ health The Legislature is considering providing money to cover the veterinary costs of retired law enforcement dogs. SB 226 creates the Care for Retired Law Enforcement Dogs Program within the Department of Law Enforcement. The legislation will set aside $300,000 in recurring funds from the General Revenue Fund, allowing FDLE to contract with a nonprofit corporation to manage the veterinary care. The Senate Appropriations Committee OK’d the bill Thursday. Powell, from West Palm Beach, said these law enforcement dogs are unique partners in crime-fighting.
Marijuana industry is stoked Florida’s burgeoning marijuana industry was alight with joy last week as Sen. Ben Albritton‘s agritourism bill cleared its final committee meeting before a full Senate vote. SB1186 clears up language regarding how lands used for agritourism are taxed. Currently, agricultural lands used for a “bona fide” purpose are taxed at a lower “assessed” value than other properties, which are taxed based on their “just” value, the land’s highest value. The lower tax rate serves as an incentive for farmers to keep agricultural land instead of making more profit by selling the same land for a different use, like retail or building condos.
This will limit the number of health care lobbyists Former lawmakers who lobby their ex-colleagues in the Legislature or executive branch could face a $10,000 fine and other sanctions starting next year, after the Senate unanimously passed HB 7001 last week, sending it to Gov. Ron DeSantis’ desk. The bill, which takes effect on Jan. 1, 2023, would also apply to the heads of state agencies under DeSantis or the Cabinet. That bill and another measure (HB 7003) that applies the same ban to ex-judges and passed unanimously are implementing a constitutional amendment approved by voters in 2018 to extend the current two-year lobbying ban on ex-lawmakers to six years.
Nursing home staffing changes clear last House panel Legislation to “modernize” nursing home staffing requirements by reducing the number of certified nursing assistant hours and allowing nonnursing care to be provided instead cleared its last panel Wednesday in a 15-5 vote. Before passing the measure, the committee agreed to tag an amendment onto HB 1239, filed by Rep. Lauren Melo. The bill requires nursing homes to conduct facility assessments to determine the staff needed “to provide the level and types of care needed for the facility’s resident population considering the types of diseases, conditions, physical and cognitive disabilities, as required by federal rule.” The level of resident care required would be determined by the facility assessment as well as the resident’s direct care plan. At a minimum, the bill would require facilities to maintain 2 hours of CNA staffing, a reduction from the current 2.5-hour requirement.
House community-based care proposal could sap $17M from Southeast Florida to boost funding elsewhere Multiple foster care providers in Southwest Florida sought a change in state funding formulas to address inequities ahead of Session. And the House might wipe out any problems for those providers. But with the funding increase comes a change in how dollars are allocated. That change could see more than $17 million cut from the budget of Citrus Health Network, which serves as the provider in Miami-Dade and Monroe counties. Citrus’ budget sits at around $77.5 million in the Fiscal Year 2021-22. That $17 million figure represents a 22% cut, resulting in significant services being scaled back. ChildNet Broward, which serves Broward County slightly to the north, would see a cut of nearly $6 million from a $61.5 million budget, a 9.6% cut.
Hello, how are you? via Christine Jordan Sexton of Florida Politics — Should phone calls be an acceptable way to deliver health care services? It depends on who you ask. The Senate thinks so, unanimously passing SB 312, which eliminates an exclusion on telehealth by audio-only. The House’s version of the bill (HB 17) does not make that change. Instead, the House measure focuses only on using telehealth to prescribe controlled substances. That change also is included in the Senate bill. That portion of the House bill is identical to the Senate bill. It is not clear that the House will reconsider. The group pushing the loudest to change state law to allow for audio-only telephone calls is Americans for Prosperity, which included the issue in its 2022 legislative agenda.
— FOR YOUR RADAR —
In addition to the coverage on Florida Politics, these stories are worthy of your time.
“How to keep track of your health information” via Heidi Goldman, U.S. News and World Report — In a perfect world, your health information would start following you from the moment you’re born. Every documented detail — vital signs, doctor visits, medical test results, diagnoses, prescriptions and hospital stays — would trail you like a magnificent magnetic cape, a vast health history attached to you and accessible in one convenient spot. Unfortunately, the world has yet to develop a system capable of tracking the volumes of health data you generate. You’re left to gather it on your own from each provider, stitching together a patchwork of medical minutiae and milestones stretching across the decades.
“Thousands of Florida children could lose Medicaid coverage in months ahead, study says” via Daniel Chang of the Miami Herald — Medicaid has become a significant safety net for families during the COVID-19 pandemic, covering about half of U.S. children, including about 2.4 million kids in Florida. But those gains in Medicaid coverage are likely to plummet when the federal government declares an end to the pandemic-related public health emergency, according to a recent report from Georgetown University researchers. When that time comes, possibly as soon as July, states will be required to restart annual renewals for everyone in their Medicaid programs if they have not been able to verify eligibility — an enormous administrative undertaking that could lead to millions of children losing coverage for some time, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
“Florida nursing homes want more workers from abroad amid staff shortages” via Hannah Critchfield of the Tampa Bay Times — Amid a growing workforce shortage, Florida nursing homes are joining hospitals in recruiting nurses from abroad to adequately staff facilities. Some home care agencies have also begun to recruit overseas workers as well. “The demand for long-term care facilities is huge,” said Brian Hudson, senior vice president for Avant Healthcare Professionals, a company that is not affiliated with AdventHealth and recruits nurses from other countries to work in the U.S. AdventHealth is actively hiring for 10 overseas nurses at nursing homes across Central Florida, according to Ashley Jeffery, a spokesperson for the health care company. Jeffery said this is the first year the company is seeking nurses from abroad for its long-term care homes. Advent continues to hire internationally for many nursing jobs at area hospitals.
“A flurry of new hospitals are on the way. Here’s an inside look at the building boom.” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — Hospital wars are heating up in South Florida and across the state — with private and public health systems building in new markets and expanding their existing properties. The flurry of activity takes big-name health systems into neighborhoods that previously seemed off-limits and gives way to the most significant construction and expansion undertakings in decades. In Sunrise, two hospital systems are battling to bring a new hospital to the suburb in Broward County, with both moving forward on parcels only 4 miles apart. In South Broward, Memorial Healthcare has knocked down a Toys R Us to build a $125 million state-of-the-art cancer center, the first on the county’s west side. In Central Florida, Orlando Health has begun the largest expansion in its 103-year history, opening hospitals in counties well outside of its home base.
“Mayo Clinic continues expanding Jacksonville campus with $432 million project to add five hospital floors” via Matt Soergel of The Florida Times-Union — Mayo Clinic announced plans to add five floors to the top of its main hospital on the Jacksonville campus, expanding to 13 floors with 121 new beds and room to grow in the future. Construction on the $432 million project will begin this year and be completed by 2026. Operations at the current eight-floor hospital will continue as usual during the work, said CEO Kent Thielen. Three new floors will be finished, while the others will be available when needed. In the last six years, Mayo said it had invested about $1 billion in projects at the center off San Pablo Road and that by 2026 it will have more than doubled its space in that period.
“Florida health leaders spur discussions on behavioral health reform, value-based care” via Nicole Pasia State of Reform — Four insightful health care leaders offered an on-the-ground look at Florida’s health care system at our 2022 Federal State of Reform Health Policy Conference earlier this month. Highly-discussed topics included behavioral health, community-based care, and moving toward value-based payment models. Joining the conversation was Beth Kidder, managing principal at Health Management Associates, Jennifer Sweet, CEO of Aetna Better Health of Florida; Mary Mayhew, CEO of the Florida Hospital Association; and Nathan Landsbaum, CEO of Sunshine Health Florida.
“Encompass Health and Lee Healthcare Holdings, LLC announce a collaboration to jointly own and operate two inpatient rehabilitation hospitals in Florida” via Encompass Health Corp.–The Board of Directors of Lee Health approved its investment in this collaboration with Encompass Health. One of the hospitals will be a 40-bed, free-standing inpatient rehabilitation hospital currently under construction in Cape Coral at 1730 NE Pine Island Road and scheduled to open in May 2022. The other hospital, anticipated to open in 2024, will be a 60-bed, free-standing inpatient rehabilitation hospital located in Fort Myers on Lee Health’s Gulf Coast Medical Center campus. When the Fort Myers hospital opens, Lee Health intends to relocate its existing 60-bed rehabilitation unit at Lee Memorial Hospital to that new hospital.
“Broward Health updates its patients on UnitedHealthcare contract negotiations” via Broward Health — For months, our team has been working with UnitedHealthcare to achieve a new contract. UnitedHealthcare has historically undervalued the care our team members provide. Our discussions with UnitedHealthcare are about fairness.
— PENCIL IT IN —
Monday
9 a.m. The Senate Ethics and Elections Committee will vote on confirmation recommendations for dozens of appointees including those appointed to boards that regulate health care professionals. Place: 110 Senate Office Building.
10:30 a.m. The Senate Appropriations Committee has an all-day marathon meeting scheduled where it will take up more than 50 bills: SB 1950, which changes the operation of Florida’s statewide Medicaid managed care program; SB 768, a bill that makes several operational changes to the Department of Health and SB 1476 dealing with pharmacy benefit managers. Place: 412 Knott Office Building.
1 p.m. The House Health and Human Services Committee will consider HB 987, a bill requiring nursing homes, assisted living facilities, and developmental disabilities centers to have policies that allow visitations, and HB 79, which deals with insurance coverage for hearing aids. Place: 17 House Office Building
Tuesday
Happy Birthday to Rep. Travaris McCurdy.
10 a.m. The House is in Session and scheduled to consider several health care bills, including HB 6011, a bill that would expand who can file medical malpractice lawsuits.
10 a.m. The Senate is in Session and will consider SB 1770 regarding breast milk services; SB 1120 dealing with placing children in residential mental health treatment programs and SB 1844, which deals with procedures for admitting minors evaluated under Florida’s Baker Act.
1:30 p.m. The Senate Rules Committee will meet and consider SB 804, which changes nursing home staffing requirements.
Wednesday
Happy birthday to Sen. Manny Diaz.
10 a.m. The House is in Session.
10 a.m. The Senate is in Session.
6 p.m. U.S. Rep. Charlie Crist holds a virtual town hall meeting with Florida Voices for Health to discuss health care access and disabilities.
Thursday
Happy Birthday to Rep. Fentrice Driskell.
10 a.m. The House is in Session.
10 a.m. The Senate is in Session.
Friday
10 a.m. The House is in Session.
10 a.m. The Senate is in Session.
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