Diagnosis for 3.14.22: 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.

Well, it won’t be quite an on-time departure for the Florida Legislature, but Lawmakers expect to vote on a new $112 billion budget Monday and then head to the exits and the 2022 campaign trail.

Lawmakers agreed to extend Session by three days after failing to finalize negotiations on the budget in time to meet the deadline required under Florida law. The state requires the budget to be delivered to legislators 72 hours before a final vote.

The central drama Monday is whether lawmakers adopt the spending plans with a unanimous or near-unanimous vote. Many Democrats said during Friday’s debate ahead of the vote that they did not agree with everything in the new budget, but they also praised vast portions of it.

Session’s end also drops the curtain on significant health care policy changes for the year, although there were a few surprises at the very end.

Medicaid managed care bill? Yes.

The free-speech protections for doctors championed by Gov. Ron DeSantis? Nope. (Maybe Rep. Brad Drake shouldn’t have voted against the redistricting maps …)

A telehealth bill? You betcha.

Requiring insurers to offer hearing aid coverage for certain children? Nope.

Many other proposals crashed and burned along the way to the end, including a bid to change the state’s medical malpractice laws and an overhaul of Florida’s auto insurance health coverage.

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— State, not private, investment —

A bill requiring insurers in the state to provide hearing aid coverage for children sailed through the Senate without a single vote in opposition — but it never made it to the House floor, despite a similar piece of legislation clearing three committees in that chamber.

Yet …

In the closing round of budget negotiations, the House and Senate settled on a final amount of $5 million to create a new children’s hearing aid program that will help children diagnosed with hearing loss but are not enrolled in Medicaid or the children’s health insurance program.

The money can purchase several items to assist children, including hearing aids, assistive learning devices and hearing aid batteries. The program will be open to families whose income is 400% of the federal poverty level or less (That’s $106,000 for a family of four according to 2021 poverty guidelines.)

As House Speaker Chris Sprowls explained when asked why the Legislature did not pass the insurance bill (SB 498) yet agreed to pay for the new program: “I think the issue is we’ve historically not done insurance mandates in the Florida House. We don’t usually think it’s good for the market. However, we do lots of investments that we think are good for kids.”

Sprowls added that the sponsors of the insurance bill — Rep. Chuck Brannan and Adrian Zika — had been working on the issue all Session, and he noted Brannan had talked publicly about his own son, who was ultimately diagnosed as profoundly deaf and could get cochlear implants when he was five.

Sprowls said that Brannan and Zika “just candidly won our hearts.”

“We wanted to help, and we thought this was a good way to do it,” he said.

Last month Brannan got emotional when he discussed his son, Chase, who has graduated from the University of Florida and is closing in on his master’s degree.

“This child only got to hear his mother’s voice for about seven years because he lost his mother when he was 12 years old. That’s my child,” Brannan said. “I don’t know where Chase would be. He certainly would be deaf. He may not be able to speak. But he’s not going to be a burden on the government or society. He makes his own way. He’s never had any special accommodations except for those devices.”

— No. 9 —

Senate President Wilton Simpson sent the message early in Session saying he was comfortable with the proposed Medicaid managed care rewrite his chamber produced. Other top Senators — Aaron Bean and Jason Brodeur — reiterated the message as the weeks went on.

And in the end, the Legislature passed a bill that enshrined much of the Senate’s positions, including reducing the number of Medicaid-managed care regions from 11 to nine and renaming the regions from numbers to letters.

Medicaid managed care contracts are worth tens of billions of dollars, and the number of plans that the state can contract within each region affects the value of the contracts.

AHCA wanted Lawmakers to update the statutes to allow the agency to issue a single statewide contract for managed care plans to bid on. Currently, the law requires the state to bid in 11 different regions.

SB 1950 also changes the number of plans in each region that can sign contracts with the state, including altering the number of minimum and maximum plans the state can contract within most regions.

Only Medicaid Regions: 6, 7 and 11 remain unchanged under the bill, which was pushed by Agency for Health Care Administration Secretary Simone Marstiller and lobbied by Chief of Staff Cody Farrill.

Medicaid Region 6 (renamed Region D under the bill) comprises Hardee, Highlands, Hillsborough, Manatee and Polk counties. Region 7 (renamed Region E under the bill) includes Brevard, Orange, Osceola and Seminole counties. Region 11 (renamed Region I under the bill) is Miami Dade and Monroe counties.

Meanwhile, the bill also affects Medicaid managed care contracts for long-term care coverage and changes the number of minimum and maximum plans allowed to be contracted with for every region except for what used to be known as Region 11.

AHCA initially proposed legislation that would have shrunk the number of Medicaid regions across the state from 11 to eight. AHCA’s plan would have trimmed three districts by merging six existing regions into just three. While the Legislature signed off on merging current Regions 1 and 2 into the new Region A and Regions 3 and 4 into a Region B, Lawmakers rejected the idea of combining current Medicaid Region 5 and 6 into Medicaid Region C, choosing to keep them separate instead.

— Medicaid cliff —

There was plenty of discussion about Medicaid during the 2022 Session, but little to no public debate about how or when Florida will begin the thorny process of redetermining Medicaid eligibility for over 5 million people currently on the program.

Enrollment is locked in because of the ongoing federal public health emergency declared because of COVID-19.

The Joe Biden administration has said that it would provide 60 days advance notice before allowing the current public health emergency declaration to expire. The current PHE is scheduled to expire April 16, 2022, which means the 60-day notice was Feb. 15. Given that the date came and went with no notice, the U.S. Department of Health and Human Services expects to extend the public health emergency and additional federal funding linked to it until July 2022.

If that is the case, Florida could continue to receive an additional 6.2% rate increase in federal Medicaid funding through the end of September or the first quarter of the Fiscal Year 2022-2023.

Meanwhile, the state’s Medicaid enrollment is at an all-time high. As of Jan. 31, 2022, the program that pays the health care costs of the poor, elderly and disabled covered over 5.1 million people. Of those, about 4 million are in a Medicaid-managed care plan.

Florida could walk away from the additional funding, and if it does, the state can fall back on Florida law, which allows the state to recertify Medicaid eligible twice annually.

Headquartered in Florida, the Foundation for Government Accountability has pushed states to end the Medicaid disenrollment freeze early by turning down the extra money.

FGA founder Tarren Bragdon served on a DeSantis health care transition task force.

“Though states would give up the temporary funding increase going forward (until the public health emergency ends), lawmakers would regain full control of their Medicaid programs, often saving more money than they would otherwise make from the funding increase,” the FGA wrote in a paper published January. “With the massive increase in enrollment and the explosion in improper payments across the nation, the Medicaid program is on an unsustainable path unless states take immediate action. Lawmakers must unlock the federal handcuffs and retake control over their Medicaid programs.”

Meanwhile, the Georgetown University Center for Children and Families released a report showing that as many as 6.7 million children nationally could be dis-enrolled from Medicaid and the Children’s Health Insurance Program (CHIP) when the health emergency expires, and children in Florida could be some of those most at risk. Researchers at the Georgetown University Center for Children and Families said 2.9 million children may re-enroll in public health programs after initially losing coverage, but about 3.8 million children will have to find other insurance coverage or will fall into the ranks of the uninsured.

Simpson downplayed any notion that Florida’s children would be at risk of becoming uninsured. “The fact that you will see folks come off Medicaid moving forward because the economy is so strong is actually a good thing, not a bad thing,” Simpson told reporters Friday.

— Sprowls’ splurge on transparency —

Sprowls believes residents want to know more about their health care costs. After learning that a state health care cost transparency website he helped create was generating little interest, the Speaker included $3 million in the state budget to help promote it.

Florida Politics reported last fall the Florida Health PriceFinder website was not gaining traction with residents. Sprowls attributed the lack of interest at the time to COVID-19 and the media, which he said had no interest in writing about the availability of the information for consumers.

“I think people don’t know that this is an option for them to check. And that is partially on the government for making sure there is a reasonable amount of resources to utilize to get the word out there,” Sprowls told Florida Politics last fall. “But it would also be helpful, I think, if other partners in the press promoted this issue. It’s not a partisan issue. It has to do with how much do (health care) procedures cost. We should all have an interest in wanting people to shop for health care.”

The website emerged from a bruising legislative battle in 2015 over Medicaid expansion, led by the Florida Senate and fomented by Florida hospitals. The website provides consumers access to cost estimates for certain health care services such as knee and hip replacements and open-heart surgery.

In four years between Dec. 1, 2017, and Aug. 1, 2021, the website had 173,361 hits, according to information by the AHCA last fall. AHCA officials told Florida Politics on the website had 44,601 hits in 2021, a 15% increase over the number of hits in 2020.

— ICYMI —

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

Veto push on AARP Florida — The group is embarking on a veto campaign, according to Zayne Smith, associate state director of advocacy. “The bill puts Florida in the wrong direction,” Smith told Florida Politics on Monday. “We hope he sees this as nothing more than a giveaway, and a veto will protect our seniors.” The nursing home industry had a successful 2022 session getting a 7% hike in rates. That Is exclusive of money the industry received to pay staff $15 an hour and a bump for inflation. The industry also will have protections from COVID-19 related lawsuits until summer 2023.

Getting it done — A last-minute deal to overhaul the state’s Medicaid managed care programs, overcoming a stalemate between the House and Senate that threatened to scuttle the effort this year. The House unanimously approved the bill (SB 1950) as amended. That will send it to DeSantis, but only after the Senate stripped out several provisions, the House had initially insisted on which were described by one Senator as “ornaments” and “hitchhikers.”

Telehealth, not telephones — Lawmakers did not get hung up on whether to allow audio-only telephone calls to be considered “telehealth.” The Legislature passed (SB 312) that allows telehealth to prescribe Schedule III, IV and V substances. But the legislation did not allow using phone calls as an option for patients.

Done deal — Sen. Darryl Rouson, who has publicly recounted his past battles with drugs and alcohol, has for years wanted to make it easier for those who struggled with addiction to help those attempting to turn around their lives. He got his wish after the governor signed a bill that would allow those recovering from substance abuse disorders to play a role in substance abuse treatment programs. Under the law that takes effect on July 1, specialists will undergo background screenings. But if they have a disqualifying offense in their background, they can request an exemption from the disqualification.

Liquid gold — Florida could soon offer donated human milk to infants as part of the Medicaid program under a bill headed to the governor. Sponsored by Sen. Lauren Book, SB 1770 would allow the state’s safety net health care program to purchase human milk for low-weight and high-risk infants.

— FOR YOUR RADAR —

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

“Florida proposed budget includes at least $101 million for mental health care” via Kimberly C. Moore of The Ledger — Florida’s proposed budget, which is scheduled for a vote on Monday, includes an unprecedented $101 million in recurring annual funds for community mental health and substance abuse services.

“One of South Florida’s largest hospital networks to hire new CEO by May” via Daniel Chang of the Miami Herald — One of South Florida’s largest public hospitals, Memorial Healthcare System in South Broward, announced a rapid timetable on Thursday in its search for a successor to CEO Aurelio Fernandez, who will retire at the end of April after six years at the helm of a $2.3 billion health care network that includes six hospitals, urgent care centers, a nursing home and 14,000 full-time employees.

“State budget will cut millions from South Florida hospitals that take neediest patients“ via Daniel Chang of the Miami Herald — South Florida hospitals, including Miami-Dade’s Jackson Health System, will lose an estimated $124 million in funding in 2022 after state lawmakers this week cut the so-called critical care fund that provides extra payments to about two dozen hospitals in Florida with the highest share of patients with Medicaid coverage.

“Jacksonville mayoral candidate Donna Deegan announces plan to increase health care access for city population“ via Mindy Wadley of First Coast News — Jacksonville mayoral candidate Donna Deegan wants to improve the health of every citizen in the city. “As many of you know, I have spent the past 20 years of my life since my life with cancer began, working with cancer patients who have a tough time accessing the health care they need,” she said. “I’ve spent a great deal of time looking at how we might improve that access for every citizen in Jacksonville.”

“Pandemic medical innovations are leaving behind people with disabilities“ via Lauren Weber of Health News Florida — Divya Goel, a 35-year-old deaf-blind woman in Orlando, has had two telemedicine doctors’ appointments during the pandemic. Each time, they denied her an interpreter. Her doctors told her she would have to get insurance to pay for an interpreter, which is incorrect: Under federal law, it is the physician’s responsibility to provide one.

— ROSTER —

The Memorial and Joe DiMaggio Children’s Hospital Foundations added three members to its board of directors: Karen Prange, Sean Deviney, and Marcia Tabatchnick. The board is composed primarily of regional business leaders, physicians, and senior executives dedicated to philanthropy that supports the mission of the Memorial Healthcare System.

— PENCIL IT IN —

Monday

Noon. The House is in Session.

Noon. The Senate is in Session.

2 p.m. The Joint Legislative Auditing Committee meets to select legislative and executive branch lobbying firms whose 2021 quarterly compensation reports will be audited.

Tuesday

Sen. Audrey Gibson‘s birthday.

Wednesday

Rep. Chip LaMarca‘s birthday.

Thursday

Rep. David Smith‘s birthday.