Diagnosis for 12.3.21: Checking the pulse of Florida health care news and policy

Happy holidays from Diagnosis, our newsletter covering the intersection of health care policy and politics.

This edition is all about the numbers, with studies showing Florida’s minimum wage increase could cause an increase in health care costs and another report showing medical marijuana users are on the rise. The Florida Department of Law Enforcement also released data showing drug-related deaths increased from 2019 to 2020 amid the COVID-19 pandemic.

In other news, the Legislature wrapped its final committee week of 2021 — meaning the 2022 Legislative Session is on deck. Diagnosis will bring you up-to-date on the various proposals coming out of Tallahassee when the Legislature officially starts meeting in January.

Though committee weeks are finished for 2021, various health care boards are set to meet next week in Tallahassee. Florida Politics will have you covered.

Now onto this week’s slate of news.

— MINIMUM WAGE WOES —

Raising the state’s minimum wage to $15 an hour by Sept. 30, 2026, will, in the aggregate, require an additional $533.5 million in funding in the state fiscal year 2027-2028. That’s according to a new actuarial analysis prepared by the Milliman Group for the Agency for Health Care Administration and obtained by Florida Politics.

The Nov. 17 analysis also reviews the impact minimum wage will have in terms of state health care costs in “rate years.” Rate years are in effect between Oct. 1 and Sept. 30. In terms of rates, the minimum wage will, taken together, increase rates by $524.4 million by the rate year 2027-2028.

Actuaries reviewed the impact of increased wages on hospital services, professional services, home and community-based services, and nursing facility services.

The Florida Legislature earlier this year directed all state agencies to review the impact of the new state minimum wage requirements approved by voters.

Chair of the Senate Health and Human Services Appropriations Subcommittee, Sen. Aaron Bean, said the chamber is still reviewing the Milliman analysis findings.

On Nov. 3, 2020, Florida voters approved constitutional Amendment 2, which increased the state’s minimum wage requirements, upping it to $10 on Sep. 30 and increasing it by another $1 annually until Sept. 30, 2026, when it reaches $15 an hour.

— TOKING UP, UP, UP —

The number of patients in Florida who qualified for medical marijuana in the last year increased, as did the number of physician certifications for medical marijuana and certifications for smoking medical marijuana, a new draft report detailing Florida’s medical marijuana market shows.

According to a draft copy of the 2022 Physician Certification Pattern Review, there were 653,190 patients certified for low THC marijuana or medical marijuana in the state between Oct. 1, 2020, and Sept. 30, 2021. That’s a 47% increase in the number of patients from the previous year’s report. The number of new patient enrollments per month peaked in April 2021, with 30,997 newly certified patients for the month.

Physicians wrote 975,267 certifications for medical marijuana in the time under review, which is also a 47% increase in the number of certifications issued from the prior year.

The number of physicians qualified to certify patients for medical marijuana actually decreased. There was a 5% reduction in the number of physicians, with just 2,563 meeting the state’s requirements; 2,700 physicians qualified to certify patients in the prior year’s report.

The 2022 draft report shows most of the certifications for medical marijuana continue to be done by a small share of physicians. The report found 80% of certifications in the time under review were issued by 16% of qualified physicians.

The report on medical marijuana activity in the state is compiled annually and presented to the Florida Boards of Medicine and Osteopathic Medicine to review.

Ten specific medical conditions qualify patients for medical marijuana certification: post-traumatic stress disorder, HIV, AIDS, Crohn’s disease, Parkinson’s disease, cancer, epilepsy, amyotrophic lateral sclerosis, and multiple sclerosis. Moreover, patients who suffer from conditions like those or have chronic nonmalignant pain also qualify for medical marijuana. Terminal patients also qualify.

Physicians can certify their patients for low THC marijuana or traditional medical marijuana.

PTSD diagnoses accounted for 38.7% of the certifications, followed by a broad category of similar diseases, accounting for 27.1% of the certifications. Chronic nonmalignant pain accounted for 13.6% of the certifications.

Meanwhile, the number of orders for smoking medical marijuana in 2022 increased by more than 52% over the prior 12 months, according to the report, with 2,785,813 orders. The number of orders for edibles, which hit the market in August 2020, was 2,782,254.

Florida voters in 2016 passed a constitutional amendment that broadly legalized medical marijuana. Smokable marijuana became legal on March 18, 2019, at the behest of Gov. Ron DeSantis.

Meanwhile, the Florida Boards of Medicine and Osteopathic Medicine adopted rules earlier this year that physicians must follow when ordering medical marijuana for patients. The new consent form advises patients with smoking certifications to check their marijuana supplies because buds can get infected with mold or mildew that pose health risks. The new rules require physicians to document in the patients’ medical records that they checked the database.

— MEDICAID MONEY INCOMING —

Hospitals in nine regions across the state will receive the first installment of $1.8 billion in Medicaid money made possible under a newly approved supplemental financing program.

Money for the Hospital Direct Payment Program for Year 1 is made possible under a budget amendment that has been under legislative leadership review for the last two weeks, sources say.

There are concerns about the financial security of the supplemental hospital financing program, though, after the Centers for Medicare & Medicaid Services (CMS) rejected three direct payment programs in Texas.

CMS sent Texas Medicaid officials an eight-page letter explaining its decision to reject the two DPP programs, including its concerns that the local dollars used for the program did not meet the requirements to draw down federal matching Medicaid dollars.

The letter resulted from court-ordered negotiations placed on CMS after it moved to rescind the state’s 1115 Medicaid waiver. The waiver was renewed shortly before President Donald Trump left office. But the Joe Biden administration moved to rescind it because the state never allowed public comment as required by rules.

The state took the Biden administration to federal court. The court then issued a preliminary injunction that put the brakes on the rescission and subsequently ordered CMS to continue negotiating the nuances of the five payment programs authorized under the 1115 waiver.

Texas health officials filed a motion to enforce the preliminary injunction in federal court on Nov. 2, accusing the Biden administration of ignoring the requirement to negotiate the five programs in good faith.

“As a direct result of CMS’s failure to respect the preliminary injunction … Medicaid providers are unable to access over $7 billion in critical funding needed to provide care to the most vulnerable Texans, and Texas is at risk of losing approximately $6.5 billion due to the impact on the state’s budget-neutrality expenditures,” the Texas court filing notes.

— FBHA: BEWARE THE BLUES —

The Florida Department of Law Enforcement Medical Examiners Report shows total drug-related deaths increased 17% in 2020 over the prior year’s death toll for the same period. Specifically, the number of opioid-related deaths in 2020 increased 28% over the previous year’s experience.

“In normal circumstances, holiday stresses and demands can trigger anxiety and depression, but this combined with the disruptions caused by the COVID-19 pandemic present complex challenges to those who are trying to achieve sobriety,” said Florida Behavioral Health Association President and CEO Melanie Brown-Woofter. “This problem is not unique to Florida; unfortunately, we are seeing escalating overdose numbers across the entire country.”

Most recently, the Centers for Disease Control and Prevention (CDC) released statistics showing that during 12 months from May 2020 to April 2021, more than 100,000 people nationwide died of drug overdoses. Of those deaths, 75,000 were due to opioid use.

“We cannot attribute all of these overdoses solely to the pandemic,” Brown-Woofter continued. “The last two years simply unveiled the opioid epidemic that has been going on for years.”

Most FBHA members have a toll-free helpline available. Florida’s First Lady Casey DeSantis’ Hope for Healing website helps connect those in crisis to services.

The Substance Abuse and Mental Health Services Administration provides techniques to recognize and resolve holiday triggers. The National Council for Mental Wellbeing also has some simple tips for handling holiday stress, such as talking to a friend or going for a walk.

— HCA, FAMU JOIN FORCES —

HCA Healthcare is donating $1.5 million to Florida A&M University’s (FAMU) School of Allied Health Sciences to fund scholarships and internships for students seeking a health care career.

“We are excited to announce this partnership with FAMU to further our commitment to advancing diversity in health care,” said Sherri Neal, chief diversity officer of HCA Healthcare. “This partnership demonstrates our continued efforts in developing a diverse pipeline of health care professionals and future leaders, which allows us to continue to make a positive impact on the communities we serve.”

“Through Capital Regional Medical Center and HCA Healthcare’s Tallahassee-based North Florida Division, the health system has a long history of collaboration with FAMU,” added Chuck Hall, group president of HCA Healthcare. “This partnership strengthens our relationship with a leading university, provides exciting health care career opportunities for FAMU students, and helps advance diversity in health care.”

The $1.5 million donation comes as part of a commitment by HCA Healthcare to donate $10 million to Historically Black Colleges and Universities (HBCUs) and Hispanic Serving Institutions (HSIs) over the next three years. The effort aims to encourage students to pick a health care profession and diversify the field.

“The ongoing pandemic reminds us daily of the crucial importance of providing an adequate pipeline of skilled health care professionals,” said Florida A&M University President Larry Robinson. “This timely and generous partnership allows us to train more students who will join the front lines of those fighting to protect America’s health. We thank HCA Healthcare for its leadership and vision.”

FAMU’s School of Allied Health Sciences offers health care education in five different divisions: cardiopulmonary science, health care management, health informatics, information management, occupational and physical therapy.

— HEALTH EQUITY EXPANDING —

The National Committee for Quality Assurance (NCQA) is growing its services to provide more equitable health services to communities of color, and the Florida-based provider Simply Healthcare Plans will be part of the pilot program.

NCQA is developing a Health Equity Accreditation Plus program “to guide organizations in establishing processes and cross-sector partnerships to continuously identify and address the social risk factors in the communities where they operate and the social needs of the individuals they serve” according to a release from the organization.

NCQA is a 501(c)(3) that aims to improve health care quality through various accreditations and instructional tools. The group is partnering with Simply Healthcare and eight other organizations to help them set up “standardized structures, processes, and goals that elevate health equity as a recognized priority.”

The Health Equity Accreditation Plus offering builds on NCQA’s regular Health Equity Accreditation program, launched in September. Both programs would see NCQA working with organizations looking to ensure health coverage and care is being offered equitably across various communities in Florida and the U.S. Simply Healthcare’s participation is notable, as it has a Medicaid contract with the Agency for Health Care Administration.

NCQA will be offering more information on its equity services during a Tuesday, Dec. 14 webinar running from 1-4 p.m.

— HALL OF FAME ENERGY —

The Florida Association of Health Plans recently wrapped its annual conference in Orlando.

The event featured an all-star lineup of speakers, including NFL Hall of Famer and former Florida State University Seminole Derrick Brooks and keynote speaker Dr. Myron Rolle, who also played football at FSU and in the pros before becoming a neurosurgeon.

Volunteer Florida CEO Corey Simon, former U.S. Amb. Nancy Brinker — who also founded The Promise Fund and the Susan G. Komen Breast Cancer Foundation — were also on the speaker list alongside elected leaders and others.

FAHP’s premier health care conference featured insights and best practices shared by industry experts on the most critical topics impacting the state and nation’s health care landscape today.

A short video capturing the energy of the conference, courtesy of the Pro Football Hall of Fame’s partnership with Sunshine Health, is available below.

To watch the video, click on the image below:

— ‘FLU WEEK’ LOBBYING —

National Influenza Vaccination Week begins Dec. 5. The CDC established the observance in 2005, with Dec. chosen as a statement that, even now, it’s not too late to get a flu shot.

Just as with COVID-19, inoculation against flu is particularly important for people with underlying health conditions. According to the CDC, about 90% of adults hospitalized for flu have at least one coexisting medical issue — and yet only about half of those ages 18-64 with a chronic condition received a flu shot last year. Nevertheless, even healthy children can experience severe consequences from the flu. Everyone over the age of 6 months old is recommended to receive one each year.

The technology used for current flu vaccines relies on tracking the prevalence of various viral strains and attempting to match the inoculation against those that are most likely to spread that year. It’s a bit of a gamble, given the amount of time it takes to produce enough vaccines. And, even when perfectly matched, the flu shot’s efficacy isn’t as strong as those developed for COVID-19.

The success of the latter vaccines may be attributed to the use of mRNA to trigger the body’s immune response to particular viral codes. Indeed, COVID-19 vaccines are nothing short of a medical miracle in terms of both how efficacious they are and how quickly they were developed by scientists in response to the global crisis. The success of mRNA for COVID-19 immunity has led scientists to consider whether these same methods could also work for inoculating against influenza.

Pfizer, for one, has already begun studying mRNA “next-generation” flu vaccines and has started clinical trials on patients. While we wait to see the outcome of these studies, Floridians must continue to prepare against the reality of flu as we know it.

All but 10 Florida counties are reporting at least mild flu activity, at press time, with four counties reporting at least one known outbreak. Between 2014 and 2019, an average of about 2,800 Floridians died annually from influenza. In 2020, that number was 3,195.

Last year, just 41.7% of Floridians got a flu shot — the lowest rate reported in any state and significantly fewer than the 52% of Americans who did so. Specifically, 38.4% of Florida adults got the flu shot, as did 47.7% of Florida children. This compares with 50.2% of American adults and 58.6% of American children.

Efforts include bolstering confidence in flu shots, focusing on the safety of the vaccinations, and messages regarding better outcomes among those vaccinated if contracting the flu. Other efforts aim to debunk common myths, such as the belief that the vaccine can cause people to contract flu itself or that somehow getting the flu shot could make a person more susceptible to other respiratory viruses.

Medical professionals, state agencies, and biomedical companies all have a stake in educating the public about the safety and utility of immunization.

For their part, most of the major flu vaccine manufacturers also have a presence in Florida’s political process. These include AstraZeneca, retaining Brian Ballard, Christopher Hansen, and Joshua Spagnola; Sanofi, with Gary Hunter; GlaxoSmithKline PLC, with Christopher Bryce and Stephen Winn; and Pfizer with Travis Blanton, Amy Christian, Jon Johnson, and Darrick McGhee, Sr.

There hasn’t been a bill filed in the Florida Legislature that references “influenza” since 2020, predating the COVID-19 pandemic. But with the heightened focus on all things vaccination-related and relevant medical breakthroughs on the horizon, it is no doubt these companies and others in the biomedical space have plenty of debates ahead.

In the meantime, get your flu shot, wash your hands, and stay safe out there.

— STATUTORY RULE CHANGES —

Diagnosis sifts through the latest statutory and technical rule changes, so you don’t have to.

— The Florida Board of Nursing proposes amending Rule 64B9-15.006 to clarify language regarding clinical instruction and specifically address clinical simulation in place of mandatory clinical instruction in a long-term care setting. More here.

— The Florida Board of Psychology proposes amending Rule 64B19-17.002 to add new disciplinary guidelines pursuant to recent statutory changes. More here.

— The Florida Board of Psychology proposes amending Rule 64B19-12.006 to reduce the change of status fee for limited licenses from $50.00 to $25.00. More here.

— The Department of Health issued Emergency Rule 64ER21-19, which establishes the application window for the Pigford/BFL batching cycle. More here.

— The Board of Acupuncture proposes updating Rule 64B1-4.001 to clarify education requirements. More here.

— PENCIL IT IN —

Tuesday

9 a.m. — The Social Services Estimating Conference committee meets to discuss the Florida KidCare caseload.

Place: 117 Knott Office Building, the Capitol. Tallahassee.

Noon — The Florida Health Information Exchange hosts a webinar on the Medicaid Encounter Notification Service (ENS).

Attend virtually: gotowebinar.com/register.

2 p.m. — The Florida Board of Chiropractic Medicine Probable Cause Panel meets.

Call (888) 585-9008; participant code: 136103141. A copy of the agenda is here.

Wednesday

10 a.m. — The Florida Board of Optometry Probable Cause Panel meets.

Call (888) 585-9008; participant code: 136103141. A copy of the agenda is here.

10:40 a.m. — The Florida Supreme Court hears oral arguments in Agency for Health Care Administration v. Ybor Medical Injury & Accident Clinic, Inc. The state is challenging an appellate court’s decision to put on hold its decision to withdraw the provider’s application for renewal.

Place: Florida Supreme Court building. Tallahassee.

Thursday

10 a.m. — The Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling meets.

Call (888) 585-9008; participant code: 12375828. A copy of the agenda is here.

1:30 p.m. — The Medicaid Drug Utilization Review Board meets.

Attend virtually: magellanhealth.zoom.us.

1:30 p.m. — AHCA holds a hearing on proposed Rule: 59A-26.002 regarding forms and licensure requirements for applicants with certificate of need exemptions.

Call (888) 585-9008; participant code: 476211242.