Diagnosis for 2.6.22: Checking the pulse of Florida health care news and policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

Wednesday marks the midway point of the 60-day Legislative Session. This is when budgets are negotiated, compromises are reached on legislation, and bills killed with avidity. It’s the time when those deeply invested in what happens in the Legislature start to panic or start counting the hours and days until they can do their victory formation.

The pace also begins to pick up because committees will soon wrap up their work for the year, and the deadline for the budget is about to appear on the horizon. Sometime in the next two weeks, lawmakers will shift from saying there’s still time to work out a deal to wait until next year.

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— Health plan revamp —

Lawmakers appear poised to revamp the health insurance program used by tens of thousands of state employees — as well as legislators and other top state officials — by including in their budget plans to competitively bid the state’s $3.1 billion program and have new contracts inked and in place for coverage in two years.

Neither chamber is proposing any changes to the state group health insurance plans for the next benefit year starting Jan. 1. Employee premiums would remain at their current levels. But included in the House and Senate budget documents released late Friday are directives for the Florida Department of Management Services (DMS) to begin the process of selecting a contractor to administer HMO and pharmacy benefit manager services for 2024.

The House has included the directive in its proposed spending plan for the Fiscal Year 2022-2023 and authorizes the department to begin working on the procurement immediately. The House also earmarked nearly $3 million for what it hopes are cost-saving initiatives. It has earmarked $2.1 million, $900,000 of which is recurring, for a cloud-based data analytics solution for fraud and abuse and $600,000 for a cost-benefit analysis.

The Senate has included a revamp in its proposed bill — SB 2502 — also known as the implementing bill for the budget. Both chambers also have released conforming bills that ratify DMS rules that establish nine “regions” across the state. DMS was directed to establish the regions in 2019 as part of an eleventh-hour effort by the House to revamp the state health insurance plan.

While both conforming bills ratify the DMS rules, the House bill also requires DMS to establish anti-fraud units. The House conforming bill, PCB APC 22-05, would allow certain state employees who leave their jobs on or after July 1, 2022, to enroll in the state group plan within two years after their departure.

Only employees who worked at least six years for the state and were enrolled in the state group plan at their departure could qualify. Part-time employees would not be eligible, nor would those employed by the state university system.

The House bill also eliminates a failed attempt to revamp the state health insurance program that was long championed by the House and passed in 2017. The law directed the DMS to offer state employees access to one of four health insurance plans — named after metals with different actuarial values. Employees who chose less expensive plans than what the state paid to the premium could be used to increase their salary. An actuarial analysis shows that the law, if implemented, could increase costs by $525 million annually. Lawmakers have agreed to hold the law in abeyance. The House bill would strike the ill-conceived program from the books.

That provision is not in SPB 2506, the Senate confirming bill to ratify the DMS rules.

The move to competitively bid the $3.1 billion program comes as economists revised the fiscal outlook for the state employee health insurance trust fund. The fund, a combination of employees’ monthly premiums and state tax dollars, is projected to have a $61.8 million deficit in the Fiscal Year 2023-2024. The deficit is due to a decline in health plan enrollment in the Fiscal Year 2021-2022 and higher than anticipated expenses for those covered. Data show 3,312 fewer state employees in the health plan in the current fiscal year than projected.

— In or out? —

Should Medicaid dental care continue to be a separately procured program, or should it be rolled back into the state’s Medicaid-managed medical assistance program?

On Monday, members of the House Health Care Appropriations Subcommittee will wrestle with that and other high-profile issues when discussing HB 7047. The delivery of dental care is not the only issue getting attention in the House bill, but it is one of the most divisive. The House bill rolls the dental program back into the statewide Medicaid-managed medical assistance plan, a move supported by Florida’s Medicaid Director Tom Wallace. Wallace told lawmakers in November that contacting one provider for dental and medical care improves the continuum of care and “seems to be the best approach.”

But Tallahassee dentist Astrid Gonzalez, who opened Tiny Teeth in 2017, sees things differently. Gonzalez contacted Florida Politics because she wanted to testify on the bill but had a previously scheduled surgery time in the operating room she jockeyed to get.

Gonzalez, who moved to Florida from Pennsylvania to be close to her parents, has always practiced in a Medicaid-managed care system. For one year, she worked in Florida’s Medicaid-managed medical assistance program. She has had contracts with managed dental companies for the last three years. Gonzalez did not know how many patients her growing business lost when the state changed how it procured dental services, but she knows some children fell through the cracks. Switching it back, she said, will be unnecessarily disruptive.

“I know I am able to provide dental care to these kids, and I’m certain that changing the system would cause major disruptions in the delivery care,” she said. “Would it last forever, no? But one day, a child needs to go to the dentist but can’t … that’s why I want to be able to provide care for them.”

The Senate’s version of the Medicaid-managed care bill keeps intact dental care the way it is currently being handled. When asked about the Senate’s position to continue the separate dental procurement, Senate President Wilton Simpson told reporters Thursday, “we are very comfortable with where the Senate bill is.”

Meanwhile, it is unclear when the Senate will consider SB 1950 again. Its next stop is the Senate Appropriations Subcommittee on Health and Human Services. But Sen. Aaron Bean said the Subcommittee he chairs is not slated to meet again until Feb. 16. The agenda for that meeting has not yet been set. On Friday, Bean, a Republican from Fernandina Beach, told Florida Politics that he was “hopeful that we will eventually consider that bill.”

— Ladapo and manners —

State Surgeon General Joseph Ladapo will go before Senators for a second time this week, and it probably won’t go any better than the first time around.

The Harvard-trained doctor picked by Gov. Ron DeSantis to lead the state Department of Health was already a lightning rod for controversy because of skeptical stances on vaccines and masks and his refusal to wear a mask in Sen. Tina Polsky’s office after she asked him to. His reluctance to answer questions from Democrats straightforwardly during his first confirmation hearing prompted all of them to storm out.

He will go before the Senate Ethics and Elections Committee this Tuesday, where Republicans hold a 6-4 majority. So, it’s highly unlikely this Committee will be thumbs-down on his confirmation. (The Committee only recommends whether someone should or should not be confirmed. The full Senate can still vote on a confirmation even if a Committee makes a negative recommendation.)

But Democrats will probably ask Ladapo about the information contained in a background screening report first disclosed by the Tallahassee Democrat. A former supervisor at the University of California at Los Angeles was sharply critical of Ladapo and said he should not be in his current post.

“In my opinion, the people of Florida would be better served by a Surgeon General who grounds his policy decisions and recommendations in the best scientific evidence rather than opinions,” the unnamed supervisor told the investigator who did the screening.

The supervisor said Ladapo created “stress and acrimony” among his co-workers due to his opinions on COVID-19 and “who felt that his opinions violated the Hippocratic oath that physicians do no harm.”

Ladapo, as well as representatives of the DeSantis administration, pushed back on the criticism. When Senate President Simpson was asked, the Trilby Republican on Thursday quickly said, “I suspect that professor did not go to the University of Florida either,” before pivoting to another question.

That referenced a previous jab that Simpson made where he said Ladapo lacked manners because he went to Harvard instead of UF. But Simpson’s sharp shift to another question signals that he doesn’t want Ladapo’s nomination to be too much of a distraction.

— Free speech or free reign? —

DeSantis is throwing his support behind bills that would prohibit state regulators from sanctioning or penalizing doctors and health care practitioners for any comments they make on social media.

On Monday, the Senate Judiciary Committee will consider SB 1184, dubbed the “health care provider freedom of speech” bill.

The legislation aims to prevent a crackdown on doctors accused of spreading misinformation about COVID-19, a trend occurring across the country. The Federation of State Medical Boards reported an uptick in complaints against licensed medical professionals for disseminating false or misleading information. The organization announced that 67% of state medical boards reported an increase in complaints, and 21% had taken some sort of disciplinary action.

“We are encouraged by the number of boards that have already taken action to combat COVID-19 disinformation by disciplining physicians who engage in that behavior and by reminding all physicians that their words and actions matter, and they should think twice before spreading disinformation that may harm patients,” said Dr. Humayun Chaudhry, the president and CEO of the federation, said in a December statement.

The DeSantis administration disagrees and on Friday posted on the Governor’s Twitter account 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.’“ Of note: A complaint was filed with the DOH against State Surgeon General Ladapo, but it was never pursued.

The bill requires the licensing board or the Health Department if there is no board to prove “beyond a reasonable doubt” that the licensed practitioner’s actions led to the “direct physical harm” of one of their patients. The board and the Health Department could get hit with a $1.5 million fine for violating the law.

A staff analysis notes that the $1.5 million liability established in the bill may deter the DOH and the boards from taking action against health care practitioners in their efforts to preserve the health, safety, and welfare of the public.

But Republican legislators backing the bill contend doctors should be allowed to espouse views without fear of being reprimanded.

“This cuts both ways,” said Sen. Manny Diaz, a Hialeah Republican. “We need to protect the freedom of speech outside of the profession regardless of the political views of the doctors.”

A similar bill has been filed in the House of Representatives. HB 687 was referred to four committees but has not been heard to date.

— New recruits —

Last week, the first class of Learn & Work Program students received their credentials to work as home health aides during a ceremony at Macedonia Missionary Baptist Church in Coconut Grove.

The Learn & Work Program is a joint effort between United HomeCare and the Thelma Gibson Health Initiative that helps cover the cost of home health aide training for residents of Coconut Grove and the surrounding areas. It hopes to put a dent in the health care worker shortage, which, without intervention, is expected to continue growing over the coming years.

Simply Healthcare Foundation, the charitable arm of health care company Anthem, seeded the project with a $50,000 contribution.

“Simply Healthcare Foundation is proud to support programs that help to address critical needs in our community. UHC’s Learn & Work Program provides vitally important skills training opportunities while ensuring Florida’s seniors can receive quality care from the comfort of their homes,” said Simply Healthcare Plans President Holly Prince. “We’re grateful to collaborate with UHC to advance our common goal of improving health equity and strengthening the health care industry’s workforce.”

The funding allowed the cohort to receive the training at no cost. Upon receiving documentation, the newly trained workers get the opportunity to work for United HomeCare, providing in-home assistance with daily activities for seniors or disabled adults. According to a news release, many of the recipients accepted positions at UHC and will begin immediately.

Rep. Nick Duran praised the program and lauded Simply for pitching in on funding it.

“Helping Floridians gain skills is one of the most impactful ways we can support underserved communities. With support from the Simply Healthcare Foundation, these individuals are launching new careers that can provide for themselves and their families for decades to come,” he said.

— Eyeing a brighter future —

According to the Florida Society of Ophthalmology, the 11 million Americans suffering from age-related macular degeneration could have better treatment options in the not-so-distant future.

Age-related macular degeneration is a condition where the macula portion of the retina is damaged, causing the gradual loss of central vision. It is the leading cause of vision loss in people over 50 years old. Effective treatments exist for the disease — people with “wet” AMD are treated with eye injections, while people with “dry” AMD are treated with antioxidant vitamins.

The Florida Society of Ophthalmology (FSO) and the American Academy of Ophthalmology highlighted the possibilities for future treatment as part of “AMD Awareness Month.”

FSO President-elect Dr. Joseph T. Nezgoda added, “As patients age, their vision changes, and so do their eye needs. Ensuring patients have access to the latest technology and treatments ensures signs of disease or conditions that could cause irreversible vision loss are caught and treated early.”

Potential dry AMD treatments include two new drugs in late-stage clinical trials targeting the “complement cascade” portion of the immune system, long identified as a culprit in AMD. Another concept under investigation is the possibility of using stem cells to replace cells that begin to die in late dry AMD.

For wet AMD, researchers are investigating whether a refillable drug reservoir — about the size of a grain of rice — can be implanted into the eye as an alternative to anti-VEGF injections. Gene therapy is also a possibility. Researchers are using already-proven gene therapy methods to deliver a treatment that enables the eye to make its own anti-VEGF medicine.

“This is an exciting time for clinical research for age-related macular degeneration that gives hope to many of our patients,” said Rahul N. Khurana, a retina specialist and clinical spokesperson for the American Academy of Ophthalmology. “For dry AMD patients suffering from vision loss, there may be treatments on the horizon. For wet AMD, there are new delivery options with longer duration of action and new molecular targets that may lead to more effective therapies.”

— Movements —

West Boca Medical Center has appointed Tim Ahlbum, Rabbi Rael Blumenthal, and Dr. Celina Moore to its board of directors. More on that here.

Memory Treatment Centers, a PURE Healthcare company (PURE), has opened a Memory Treatment Center in Jacksonville, its second in Florida. Their first Memory Treatment Center location opened in Bonita Springs in August 2021. More here.

Nextaff has opened a new health care staffing company in Sarasota co-owned and operated by John Snellings and Chris Germond.

PrideStaff announced that Matt and Amanda Becker, owners and strategic partners of PrideStaff in St. Petersburg, are opening a second staffing and employment agency in West Tampa,

— ICYMI —

In case you missed them, here is a recap of other critical health care policy reporting covered in Florida Politics this past week.

Come together — While Democratic and Republican Florida lawmakers have had a contentious debate on issues like abortion and immigration this year, the two sides came together to quickly pass 20 bills Thursday, almost all unanimously. The legislation included approving new state legislative districts, authorizing schools to stock and use medicines to counteract an opioid overdose and requiring insurance companies to provide hearing aid coverage for children.

Good news — The Florida Senate passed a quartet of bills that lawmakers say will improve the state’s substance abuse and mental health support systems. The Senate approved Bradenton Republican Sen. Jim Boyd’s bill on opioid overdose prevention (SB 544). Stuart Republican Sen. Gayle Harrell also passed SB 704, which would create additional requirements for substance abuse treatment providers to ensure they are providing genuine care. A top priority bill for Sen. Darryl Rouson, SB 282 adds the use of peer specialists as an essential part of coordinated care. Rouson, who in the past has referred to his battle with alcohol and cocaine addiction, has leveraged his more than two decades of sobriety when pushing substance abuse legislation. Sarasota Republican Sen. Joe Gruters passed SB 566 from the chamber. The bill would fix mental health and social worker licensing problems created when the Legislature eased licensing requirements in 2020.

No longer out of sight — Legislation aimed at strengthening patient visitation rights in hospitals, nursing homes, and other health care facilities across Florida now has just one more committee hearing to go before reaching the Senate floor. The bill (SB 988), dubbed the “No Patient Left Alone Act,” cleared the Senate Appropriations Committee on Health and Human Services Wednesday after roughly 15 minutes of conversation. Most speakers supported the bill outright, but one asked for better safeguards against potential disease outbreaks.

Here we go again — Lawmakers are poised to kick off debate on what could be one of the most high-profile (and controversial) issues of the 2022 Legislative Session: a repeal of the state’s long-standing personal injury protection (PIP) program. Though lawmakers voted in 2021 to repeal Florida’s no-fault auto insurance system, it’s back before the Legislature after Gov. DeSantis vetoed the bill last year. DeSantis argued the move could have unintended consequences that harmed consumers.

— For your radar —

In addition to the coverage on Florida Politics, these stories are worthy of your time.

“Bill changing Florida nursing home standards was written by the industry, emails show” via Hannah Critchfield and Kirby Wilson of the Tampa Bay Times — Republican Sen. Ben Albritton of Wauchula, the bill’s sponsor, said he filed the measure after the Florida Health Care Association brought him drafted language. But Albritton noted the bill’s language is a starting point meant to bring parties together on a solution to help ease the long-term care industry’s staffing shortages. “They brought a piece of legislation that I looked at and felt like was a starting place — with the absolute intention to do exactly what we are doing going forward. And that is, get everybody in the room,” Albritton said. “Anybody else could have brought me language.”

“Florida’s fourth COVID-19 surge came fast and strong. Here’s what the omicron wave tells us about what’s ahead” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — By now, scientists expected the omicron surge in Florida to be nearly over. Instead, omicron lingers, ensuring its place in the pandemic as the wave that infects more Floridians than all previous waves. The new forecast projects about four more weeks before the omicron wave diminishes to give Floridians a respite. While no one knows precisely what COVID-19 will do next, most experts see hope in the much larger immune population in the state. Between those who caught the virus during the omicron surge and the increasing number of vaccinated and boosted people, much of Florida should have some protection against future variants. “I can’t imagine COVID disappearing, but with all the population immunity, future waves may be small and fairly benign,” said Ira Longini, a University of Florida professor of biostatistics and co-creator of the university’s omicron model.

“Florida Blue acquires Puerto Rican company, makes Hispanic Federation donation for health and wellness” via Jennifer A. Marcial Ocasio of the Orlando Sentinel — GuideWell Mutual Holding Corporation, the parent company of Florida Blue, announced Tuesday the acquisition of Triple-S Management Corporation, the leading health care company in Puerto Rico. “Our two companies share a belief that everyone deserves access to quality health care, and a mutual dedication to health equity and the health of our communities has brought us together,” said the president and CEO of Guide Well and Florida Blue, Pat Geraghty. “This historic integration will allow us to do more to improve the health of the people and communities of Puerto Rico and Florida.”

“USF, Tampa General studies ivermectin, other drugs to treat COVID-19” via Rose Wong of The Tampa Bay Times — Tampa Bay is part of a nationwide study to examine the efficacy of three drugs to treat COVID-19, including ivermectin, the anti-parasitic medication that some believe can cure the virus. Instead, it sent people to the emergency room. The University of South Florida and Tampa General Hospital are participating in the National Institutes of Health’s Accelerating COVID-19 Therapeutic Intervention and Vaccines public-private partnership, which brings together organizations and companies to study new COVID-19 treatments and variants. Launched last summer, the ACTIV-6 study looks at how three repurposed drugs respond to the virus.

— Pencil it in —

Monday

BioFlorida Day at the Capitol. Place: Room 110 of the Senate Office Building.

11 a.m. — House Health Care Appropriations Subcommittee meets and will take up the House Medicaid managed care bill HB 7047 and HB 953, an inter-jurisdictional compact for psychology. Place: Room 17 of the House Office Building.

2:30 p.m. — Senate Judiciary Committee will consider SB 1844 regarding mental health and substance abuse. Place: Room 412 of the Knott Office Building,

2:30 p.m. — Senate Environment and Natural Resources Committee is scheduled to vote on a bill (SB 224) that lets local governments ban smoking on beaches and in public parks and prohibits smoking in state parks. Place: Room 37 of the Senate Office Building.

4 p.m. — House Civil Justice & Property Rights Subcommittee meets and will consider HB 1525, a proposed repeal of the no-fault law and requirement to carry $10,000 in state’s personal injury protection. Place: Room 404 of the House Office Building.

4 p.m. — House Insurance and Banking Subcommittee meets and will consider post-traumatic stress benefits for part-time and auxiliary law enforcement officers, correctional and part-time correctional officers, and correctional probation and part-time correctional probation officers as an occupational disease compensable by workers’ compensation benefits. Place: Room 17 of the House Office Building.

Tuesday

9 a.m. — Senate Children, Families, and Elder Affairs meets and will consider SB 1798, which increases the amount of monetary damages a victim of sexual cyberharassment may receive in a civil action from $5,000 to $10,000. Place: Room 37 of the Senate Office Building.

12:30 p.m. — Senate Ethics and Elections Committee meets and will consider Ladapo’s nomination as state Surgeon General. Place: Room 110 of the Senate Office Building.

3 p.m. — House Finance & Facilities Subcommittee meets and will consider HB 885 regarding Medicaid coverage for treating schizophrenia for Medicaid and HB 1239 regarding nursing-home facility staffing requirements and HB 1333 regarding breast milk bank services. Place: Room 17 of the House Office Building.

3:30 p.m. — House Judiciary Committee meets and will consider HB 1313 addressing unidentified persons in hospitals. Place: Room 404 of the House Office Building.

Wednesday

Day 30 of 60-day Session

8 a.m. — Florida Dental Hygienists Association Capitol Days.

9 a.m. — The House Appropriations Committee will consider the House’s proposed budget. Place: Room 212 of the Knott Office Building.

9 a.m. — The Senate Appropriations Committee will consider the Senate’s proposed budget. Place: Room 412 of the Knott Office Building.

10 a.m. — FSU Day at the Capitol. Displays on the Plaza Level, Second and Third Floor Rotundas, entertainment in the courtyard. The event is free and open to the public.

1 p.m. — The Board of Pharmacy hosts a workgroup meeting to discuss white bagging and brown-bagging pharmacy practice. Place: DoubleTree by Hilton Hotel Deerfield Beach — Boca Raton, 100 Fairway Drive, Deerfield Beach.

2:30 p.m. — House Session. The chamber will take up its bill to extend COVID-19 liability protections HB 7021 and SB 7014 and consider telehealth changes, HB 17, which is similar to SB 312.

Thursday

8 a.m. — The Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling meets. Place: Holiday Inn Tallahassee East Capitol, 2003 Apalachee Parkway, Tallahassee. Agenda here.

8:30 a.m. — Senate Health Policy Committee meets. Place: Room 412 of the Knott Office Building

9 a.m. — The Board of Pharmacy meets. Agenda here. Place: DoubleTree by Hilton Hotel Deerfield Beach — Boca Raton, 100 Fairway Drive, Deerfield Beach.

9 a.m. — House Health & Human Services Committee meets. Place: Room 17 of the House Office Building.

Noon — The House is in Session.

1:30 p.m. — The Senate is in Session.

6:30 p.m. — The Board of Physical Therapy meets. Place: DoubleTree by Hilton Hotel Jacksonville Riverfront, 1201 Riverplace Blvd., Jacksonville. Agenda here.

Friday

8 a.m. — The Board of Physical Therapy meets. Place: DoubleTree by Hilton Hotel Jacksonville Riverfront, 1201 Riverplace Blvd., Jacksonville. Agenda here.

9 a.m. — The Board of Clinical Laboratory Personnel meets. Place: Rosen Shingle Creek, 9939 Universal Blvd. Orlando.