Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
It’s springtime in Tallahassee, a time for an explosion of pollen and, sometimes, a frenzy of lawmaking.
For several decades — except in redistricting years — the annual 60-day Legislative Session was traditionally between March and May, the loveliest time of year in the Capital City. But for the last decade, during even-numbered years, Session started in January, and lawmakers finish their work and leave town by March.
Except they usually don’t. And they didn’t this year.
Lawmakers had to extend the 2022 Session by a few days to pass the only bill required by law to pass: the General Appropriations Act.
And now Gov. Ron DeSantis is calling lawmakers back into town for a Special Session on congressional redistricting. The Session is slated to start at noon April 19 and end no later than 11:59 p.m., Friday, April 22.
As of right now, the Session has not been expanded beyond that one item, although that hasn’t stopped much of the buzz and speculation.
However, one important thing to look for is whether the Legislature sends the budget to DeSantis BEFORE they return to town. If legislative leaders decide to hold off, that could give the Governor a bit more leverage as lawmakers try to strike a deal in redistricting.
And speaking of springtime, the Asthma and Allergy Foundation of America has released its annual list of so-called “pollen capitals,” and … wait for it … Tallahassee didn’t make the cut.
THEN WHAT’S THAT GREEN STUFF ALL OVER THE CARS?
Miami and Jacksonville are among the Top 25 metropolitan statistical areas in the 2022 Allergy Capitals, the latest iteration of an annual report on overall pollen counts. Other Florida MSAs included in the report include Lakeland (37), Daytona Beach (38); Orlando (41); Sarasota (42); Cape Coral (45); Palm Bay (46); and Tampa (53).
Anyone who lives in Tallahassee or has been here in the springtime for Session knows this is no place for people with allergies. After some digging, Diagnosis learned the pollen focused only on the 100 largest metropolitan statistical areas nationwide. Tallahassee’s MSA is ranked No. 141.
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— Will Florida be next? —
On Friday, the Joe Biden administration gave Medicaid officials in Louisiana the green light to extend care to 14,000 pregnant and postpartum women in Medicaid and the federal Children’s Health Insurance Program (CHIP).
“Having postpartum care can be lifesaving and lead to better long-term health outcomes for new parents and newborns,” said Health & Human Services (HHS) Secretary Xavier Becerra. “Thanks to President Biden’s American Rescue Plan, we are able to make it easier for states like Louisiana to give thousands more pregnant and postpartum people across the country access to high-quality, affordable coverage for the essential first year after birth. The Biden-(Kamala) Harris administration has made maternal health and equity a priority, and we are working to ensure every parent has access to the care they and their child deserve.”
Florida also submitted a Medicaid request to provide postpartum health care to women for one year following their pregnancy but has not yet received approval. The issue was a top priority for House Speaker Chris Sprowls, who thought it wise to tap into additional Medicaid funds under the American Rescue Plan.
Florida Medicaid Director Tom Wallace told a Medicaid advisory panel talks with the federal government about the state’s request to extend the coverage resumed in earnest after the Legislature passed SB 2526 in the 2022 Session. The bill clarifies that the Children’s Health Insurance Program will also continue to provide pregnancy and postpartum coverage to women who have turned 19 if they are not eligible for Medicaid. The change ensures the program, which provides subsidized coverage for those who earn too much to qualify for traditional Medicaid, also provides women with 12 months of coverage following the birth of their child.
Florida is one of nine states requesting approval from the federal government to extend the postpartum benefits to women in Medicaid and preteens and teenagers in CHIP.
As many as 720,000 pregnant and postpartum women across the United States could be guaranteed Medicaid and CHIP benefits for one year under the American Rescue Plan.
— Heads up —
Though DeSantis now has 15 days to veto, sign, or let a bill become law without his signature, he has been moving quickly to decide the fate of bills once legislative leaders have sent them over for his consideration. DeSantis has not taken more than seven days to either sign or veto a bill from the 2022 Session.
Given that, DeSantis could this week act on three bills sent to him March 28 even though he has until April 12. Two of the bills impact health insurance policies, and the third affects life, credit life, credit disability and long-term care policies. If signed into law, all three bills are effective July 1.
HB 459 addresses so-called step therapy programs requiring a process for an insured patient to receive a “protocol exemption” from an existing step therapy protocol. The bill requires an insurer or HMO to publish on its website and provide the insured in writing a procedure for an insured patient and health care provider to request a protocol exemption, including any applicable time frames. The bill requires an insurer or HMO granting a protocol exemption to specify the prescription drug, medical procedure, or course of treatment approved. Alternatively, an insurer or HMO denying a protocol exemption request must provide a written explanation of the denial, including the clinical rationale supporting the denial.
HB 855 requires Medicaid managed care plans to start — beginning in the 2025 calendar year — stratifying the data they are required to collect by age, sex, race, ethnicity, primary language, and whether the enrollee received a Social Security Administration determination of disability for purposes of Supplemental Security Income. The plans must report the stratified data in the 2026 calendar year. The bill also changes statutes to require HMOs to collect and report the Healthcare Effectiveness Health Plan Employer Data and Information Set (HEDIS) measures. Current law requires MMA plans to collect and report only the HEDIS measures identified by the Agency for Health Care Administration.
The bill also adds a statutory requirement for plans to report Centers for Medicare and Medicaid Services Adult and Child Core Set behavioral health measures, which are not currently required by AHCA, beginning in the calendar year 2025.
HB 1099 prohibits insurers of life insurance policies, industrial life insurance policies, group life insurance policies, credit life and credit disability insurance policies, and long-term care insurance policies from discriminating against living or prospective organ donors in coverage or eligibility solely on their status as a living organ donor. Companies that violate the law are subject to penalties under the Unfair Insurance Trade Practices Act, which allows for fines to be assessed against insurers for willful or non-willful violations of law. Fines cannot exceed $20,000 for all non-willful violations arising out of the same action or $200,000 for all willful violations arising out of the same activity.
— More money for GME —
This week, the state Agency for Health Care Administration sent two Medicaid state plan amendments to the federal Centers for Medicare and Medicaid Services for approval.
Though they are under consideration, the amendments have a March 30 effective date. One amendment alters the current outpatient hospital reimbursement methodology for indirect graduate medical education payments. The move results in an estimated increase of $60,446,514 in federal funds for the federal fiscal year 2021-2022 and an increase of $80,595,352 in the federal fiscal year 2022-2023.
The federal fiscal year runs between Sept. 30 and Oct. 1. It does not coincide with the state fiscal year, which runs from July 1 through June 30.
Meanwhile, the second amendment alters the current inpatient hospital reimbursement methodology for indirect graduate medical education payments. That amendment is expected to increase by $40,594,289 the amount of federal dollars coming to the state for the 2021-2022 federal fiscal year and an increase of $54,125,718 in federal funds for FY 2022-2023.
— No nursing homes needed in 2025 —
On Friday, the Agency for Health Care Administration announced no need to build additional nursing home beds in January 2025. The state’s announcement that there is no further need for new community nursing home beds is not final; it can be challenged through April 18.
To provide CON-regulated health care services, there must be a determination of need for the services. Twice annually, the state determines whether there is a need for new nursing homes to keep up with the demand for services. The first step in the licensure process is the fixed need publication known as a certificate of need (CON). While other parts of the CON process were repealed by the Legislature, nursing homes, hospices and intermediate care facilities continue to be regulated by CON. Providers interested in offering the care must submit a letter of intent notifying the agency of their interest. The letter of intent is nonbinding but is a prerequisite for any provider that wants to submit a CON application to the state.
The applications are competitively reviewed, and the agency awards CON applications. The agency’s decisions to award CONs can — and usually are — challenged.
— What do you think? —
AHCA is seeking public comments on its Statewide Transition Plan.
The plan is part of the state’s efforts to comply with federal Rule 42 CFR 441.301(c). The rule requires beneficiaries receiving home and community-based services to be integrated into, and given access to, community support. It includes opportunities to seek work in competitive integrated settings, engage in community life, control personal resources, and maintain the rights of privacy, dignity, respect and freedom.
The draft Statewide Transition Plan can be viewed here. AHCA is accepting public comments through April 24.
— ROSTER —
Jonathan Belolo has been named vice president of Clinical Services for VITA Recovery. In that capacity, Belolo will help to develop VITA’s clinical team and advance the clinic’s two primary programs. He will also oversee the clinical service operations at GIA Miami, which specializes in treating depression, anxiety, and other mental health disorders and is part of the VITA network.
Patricia Ares-Romero has been named vice president and Chief Medical Officer of My Psychiatrist and My TMS. In her new role, she will be responsible for expanding the health care offerings in Miami-Dade County, with an innovative approach to create a vision for the future of behavioral health.
— RULES —
— The Board of Osteopathic Medicine announces the development of an amendment to Rule 64B15-6.003 to clarify the physician assistant application. More here
— The Board of Medicine announces the development of an amendment to Rule 64B8-30.003 to clarify the physician assistant application. More here
— The Board of Dentistry proposes amending Rule 64B5-14.004 regarding continuing education requirements for anesthesia. More here
— The Board of Dentistry proposes amending Rule 64B5-12.013 regarding CPR training requirements and the submission of electronic certificates of completion. More here.
— The Division of Medical Quality Assurance proposes amending Rules 64B-9.003 and 64B-9.005 regarding temporary licenses for military spouses and licensure of active-duty military and the spouse of active-duty military. More here.
— AHCA announced it needed to extend the deadlines for several proposed rule changes. “The Agency needs additional time to develop further and solicit public comment on the rules associated with this rule-making effort,” the notices read. AHCA needs additional time for Rules 59A-16.107, 59A-18.0145; 59A-35.310; 59A-35.115; 59A-35.060.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— Kudos: Chris Clark is taking over as Chief Executive Officer of the Florida Medical Association, effective Friday. Clark has worked for FMA since 2014, taking a brief leave in 2018 from the FMA to serve as Director of Recruiting for DeSantis’ transition team. He most recently served as the senior vice president of public affairs for the nearly 150-year-old association, representing physicians statewide.
— More money, more problems: Earlier in March, lawmakers overwhelmingly passed a budget for the fiscal year starting July 1. But the question is whether, in a big election year where Florida legislators delivered on most of his key priorities, the Governor will use his veto pen sparingly. DeSantis has used his line-item veto power to slash spending every year since getting elected. In 2021, the Governor vetoed $1.5 billion, though $1 billion was in federal funds to his office. Unsure of what impact COVID-19 would have on the state’s economy, DeSantis also trimmed $1 billion in spending a year earlier. During his first year in office, DeSantis vetoed $131 million from the budget.
— That’s a lot of money: The CVS drugstore company and pharmaceutical companies will pay Florida a combined $860 million as part of the settlement of an opioid epidemic case, state officials said Wednesday. Florida Attorney General Ashley Moody said CVS Health Corp. and CVS Pharmacy Inc. will pay the state $484 million. Teva Pharmaceuticals Industries Ltd. agreed to pay $195 million and Allergan PLC more than $134 million.
— That’s a lot of money Part 2: A faculty committee charged with looking into how the University of Florida hired controversial Florida Surgeon General Joseph Ladapo says there were “numerous irregularities” in the hiring of the Harvard-trained physician and researcher that concerned committee members. The way Ladapo was hired appeared to violate the spirit of UF hiring regulations and procedures, especially in the role faculty play in evaluating the qualifications of their peers, according to a report from the faculty committee released Wednesday.
— See you in court: Equality Florida, joined by the National Center for Lesbian Rights and a handful of families, has filed a lawsuit against DeSantis to overturn parental rights legislation governing classroom instruction on LGBTQ matters, dubbed the “Don’t Say Gay” bill by opponents.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
—”Thousands lose in-network status as Broward Health and UnitedHealthcare fail to reach agreement on contract” via Ron Hurtibise of the South Florida Sun-Sentinel — Thousands of UnitedHealthcare members this morning lost in-network access to Broward Health hospitals and ambulatory care facilities after the two entities failed by Thursday to reach agreement on a new contract.
—”COVID-19 more likely to cause heart problems than vaccine, CDC study finds“ via Joseph Wilkinson of the New York Daily News — The Centers for Disease Control recently released a study that found while COVID-19 vaccination increased cardiac risks in some young men, the virus was more likely to cause heart problems than the vaccine. “The risk for cardiac complications was significantly higher after SARS-CoV-2 infection than after mRNA COVID-19 vaccination for both males and females in all age groups,” the CDC said in a study summary.
—”D.C. Medical Examiner has no plans to autopsy fetuses removed from antiabortion activist’s home, officials say” via Michelle Boorstein and Peter Hermann of The Washington Post — Ashan Benedict, D.C. police’s executive assistant chief of police, told reporters that the fetuses appeared to have been aborted “in accordance with D.C. law [and] there doesn’t seem to be anything criminal in nature about that except for how they got into this house.” The fetuses were found in a basement apartment occupied by Lauren Handy, a well-known local antiabortion protester and director of activism for Progressive Anti-Abortion Uprising.
—”Health care advocates criticize Publix’s move to end free infection, diabetes drugs” via Caroline Catherman of the Orlando Sentinel — Publix will soon end a program that since 2007 has made certain drugs for infections, diabetes, and blood pressure free for as long as a person’s doctor prescribed them, a company official confirmed. As of June 1, Publix — which has 1,297 stores in seven states, including 833 in Florida — will charge $7.50 for a 90-day supply of medications, including Metformin, Lisinopril, and Amlodipine. Amoxicillin, an antibiotic, will now be $7.50 for a 14-day supply, said Publix spokesperson Maria Brous, adding that people with health insurance could pay less.
—”Positive drug tests among U.S. workers hit two-decade high,” via The Wall Street Journal’s Will Feuer — The percentage of working Americans testing positive for drugs hit a two-decade high last year, driven by an increase in positive marijuana tests, as businesses might have loosened screening policies amid nationwide labor shortages. Of the more than 6 million general workforce urine tests that Quest Diagnostics Inc., one of the country’s largest drug-testing laboratories, screened for marijuana last year, 3.9% came back positive, an increase of more than 8% from 2020, according to Quest’s annual drug-testing index. That figure has been up 50% since 2017.
— PENCIL IT IN —
9 a.m. The Florida Rural Health Association will begin a two-day “Rural Health Educational Summit,” with speakers expected to include Department of Health Deputy Secretary Kenneth Scheppke. Place; Hilton UF Conference Center, 1714 S.W. 34th St., Gainesville.
8:15 a.m. The Florida Rural Health Association will continue the two-day “Rural Health Educational Summit,” Florida Hospital Association President and CEO Mary Mayhew. Place: Hilton UF Conference Center, 1714 S.W. 34th St., Gainesville.
8 a.m. The Florida Board of Medicine — Credentials Committee meets. Place: Tampa Airport Marriott, 4200 George J Bean Parkway, Tampa,
9 a.m.. The Florida Board of Massage Therapy meets. Place: Holiday Inn Tallahassee, East Capitol University, 2003 Apalachee Parkway, Tallahassee.
1:30 p.m. The Florida Board of Nursing meets. Place: DoubleTree by Hilton Hotel Miami Airport & Convention Center, 711 N.W. 72nd Ave., Miami.
4 p.m. The Florida Board of Medicine Rules/Legislative Committee meets. Place: Tampa Airport Marriott, 4200 George J Bean Parkway, Tampa.
8 a.m. The Florida Board of Medicine meets. Place: Tampa Airport Marriott, 4200 George J Bean Parkway, Tampa.
8:30 a.m. The Florida Board of Nursing meets. Place: DoubleTree by Hilton Hotel Miami Airport & Convention Center, 711 N.W. 72nd Ave., Miami.
8:30 a.m. The Florida Board of Respiratory Care meets. Place: Sheraton Orlando North, 600 North Lake Destiny Road, Maitland.