Diagnosis for 4.11.22: 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.

Gov. Ron DeSantis‘ administration is not giving up its push to protect physicians’ freedom of speech amid the COVID-19 pandemic. While lawmakers didn’t pass the so-called Free Speech of Health Care Practitioners Act, state Surgeon General Joseph Ladapo appeared before the Florida Board of Medicine Friday at its Tampa meeting and urged the panel not to discipline doctors for differences of medical opinions.

While legislators agreed to deliver on several of the Governor’s health care priorities, including increasing by $37 million annually the amount of cancer funding and ensuring patients and long-term care facilities residents have visitation rights, the Legislature did not pass legislation that would have made it more difficult for licensing boards to prosecute health care providers.

As state Surgeon General, Ladapo also serves as Secretary of the Florida Department of Health, which houses the state’s health care licensure boards.

Meanwhile, this past week, DeSantis signed dozens of bills, including ones involving the health care and nursing home industries. Most were signed a day after receiving them from the Legislature, including the measure to overhaul the contracting process used to select managed care plans for Florida’s Medicaid program and a bill that revised the staffing requirements for nursing homes.

The next big item to watch is what the Governor does with the $112 billion budget approved by state legislators last month.

The bill still has not gone officially to DeSantis’ desk. The anticipation is that it will probably wait until after the redistricting Special Session scheduled to start on April 19. In 2020, amid the ongoing disruption caused by the COVID-19 pandemic, state legislators approved the budget in March, but DeSantis did not act on it until June. Last year legislators approved the budget on April 30 and did not send it to the Governor until June 1.

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— Legal showdown —

Several not-for-profit hospices from across the state and the statewide association that represents hospices are headed to a showdown in administrative court this week over a proposed rule change by the Agency for Health Care Administration that the hospices contend could alter the future expansion of hospice programs. The rule challenge focuses on the information used in hospices’ certificate-of-need (CON) process.

State regulators want to alter the CON process to allow providers to note errors in underlying reports used to determine whether there is a “need” for new hospice programs. The administrative challenge by the Florida Hospice and Palliative Care Association and five hospice programs say, “this change is abrupt as it would reverse nearly 30 years of proceeding under the current rule” and “this proposed amendment would in effect allow erroneous determinations and leave impacted hospices no means for redress.”

The five initial hospice providers included Cornerstone Hospice & Palliative Care, which serves patients in seven Central Florida counties. A sixth hospice — AVOW Hospice — has joined the case as an intervenor. The Division of Administrative Hearings docket does not include from AHCA any filing that defends the rule change, although the groups challenging the rule state that “the only articulation of a reason for the proposed amendment has been a misplaced and unsupported belief that the challenged proposed amendment speculatively will avoid future administrative litigation.”

State regulators use the CON process to determine if there is a demonstrated reason to allow expansion in complex and costly medical programs. State legislators made significant revisions to Florida’s certificate of need process in 2019 and removed the requirement for hospitals and “tertiary” services. But the process remains intact for hospices.

In its rule challenge, attorneys for the hospice association and hospices contend the revisions proposed by AHCA are vague and inconsistent and exceed agency authority. But they also contend it “will result in unnecessary duplication of hospice services, a decrease in quality of care and health care resources available to hospice patients and an increase in expenses to provide hospice services.”

The filing states that AHCA could also use incorrect information to deny new hospice beds, which “would suppress need.”

— Courting the senior vote —

This past week, DeSantis signed a heavily lobbied bill that altered staffing requirements for Florida’s nursing homes which the nursing home industry contended was a much-needed change to deal with ongoing shortages at facilities around the state. The decision by the Governor was not a huge surprise since he had signaled his support of the legislation at the end of the regular session in March. But the measure was widely criticized by AARP’s Florida chapter, which called for a veto.

Rep. Charlie Crist was opposed to the bill, and he sharply criticized the Governor’s decision to back the changes. On Friday, the Democratic challenger to DeSantis tweeted: “it’s a bill that harms seniors in nursing homes and fails to address the staffing shortage. Our seniors deserve to be protected and treated with dignity. Instead, they’re being shortchanged by their Governor.”

Crist has made a pitch to seniors a big part of his campaign platform; he stressed it again during a visit to The Villages over the weekend.

But what’s also noteworthy in this year’s battle over nursing home standards is that the legislation resulted from an unusual alliance between the state’s nursing home industry and the Florida Justice Association, which represents trial attorneys in the state. Crist, who once worked for Morgan & Morgan law firm, has long relied on financial help from the state’s legal sector. His political committee, Friends of Charlie Crist, has more than 60 contributions where the listed occupation on campaign records is an attorney. For example, medical malpractice attorney Michael Trentalange donated more than $100,000 to his campaign last year. He also received large donations from attorneys who represented Florida in its landmark lawsuit against tobacco companies that resulted in a multibillion settlement.

— COVID-19 cases slowly rising —

On Friday, the Florida Department of Health released its second COVID-19 report since switching from weekly to biweekly; the latest data showed a couple of noteworthy items. Florida’s COVID-19 infection rates are starting to trickle again after sliding down to just 8,037 in mid-March. In the last two weeks, DOH reported 11,337 cases during the week of April 1 and 10,114 the previous week.

This remains substantially below where the state was earlier this year, when more than 130,000 infections were reported in January. The latest report also shows a jump in the number of people receiving COVID-19 vaccines, which appears to be driven by people receiving booster shots. DOH reported nearly 92,000 vaccine doses administered in the past week, a substantial increase over the previous week’s 48,735.

DOH reported nearly 73,000 doses were administered were additional doses of booster shots. In late March, the Federal Drug Administration authorized a second booster shot for those 50 and older and those who are immunocompromised.

— Speaking of vaccines —

The Florida Board of Pharmacy may not have heard the adage that the government moves slowly.

The Board’s Rules Committee meets this week to discuss the steps it needs to implement HB 1209, a new law approved by the Governor on April 6 that allows specific pharmacy technicians to administer vaccines to adults.

The law goes into effect on July 1. But to administer vaccines, pharmacy technicians will have to complete at least a six-hour training program approved by the Board of Pharmacy, in consultation with the Board of Medicine and the Board of Osteopathic Medicine.

The new law allows those technicians to administer vaccines on the Centers for Disease Control and Prevention Recommended Immunization Schedule for adults, the CDC Health Information for International Travel, and those licensed or authorized for emergency use by the federal Food and Drug Administration as of March 31, 2022.

Florida law currently allows pharmacists, within an established protocol under a licensed supervising physician, and registered pharmacy interns under the supervision of a certified pharmacist to administer immunizations and vaccines to adults. A pharmacy intern is a person enrolled in a college of pharmacy and actively pursuing a pharmacy degree.

The new law adds pharmacy technicians to the list of people who can administer vaccines. A pharmacy technician must complete a program that includes classroom study and clinical instruction on, among other things, pharmaceutical-medical terminology, abbreviations, and symbols; records management and inventory control; interpersonal relations, communications, and ethics; and pharmaceutical calculation

— RULES —

— The Florida Board of Medicine proposes amending Rule 64B8-52.003 regarding continuing education requirements for electrolysis. More here.

— The Florida Board of Acupuncture proposes amending Rule 64B1-7.0015 regarding continuing education requirements. More here.

— The Florida Board of Acupuncture proposes amending Rule 64B1-6.009 to consolidate and clarify methods of obtaining continuing education credit. More here.

— ICYMI —

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

— ‘Think about them as humans‘: Florida health care officials were told Friday a proposed new Medicaid rule governing applied behavior analysis (ABA) services for children with autism runs afoul of federal law and would have catastrophic consequences on the clients who require the services.

— Done deal: One of the most heavily lobbied health care bills of the 2022 Session is now law. Wednesday night. SB 1950, a Medicaid managed care rewrite, and HB 855, which addresses Medicaid managed care reporting requirements, became law last week.

— A lot of happy nursing homes: Brushing aside criticism from advocates for the elderly who said the new law that allows long-term providers to reduce the amount of “nursing” care residents must receive puts them at risk, the Governor signed into law last week one of the nursing home industry’s top priorities.

— Very necessary: More people should have access to emergency overdose treatments in Florida now that pharmacists can dispense certain opioid-blocking drugs like naloxone to “caregivers” to use.

— Hear, hear: Babies who fail their hearing tests will now get tested for congenital cytomegalovirus under a new Florida law.

— ROSTER —

USF Tampa General Physicians has named Mark G. Moseley, M.D., MHA, FACEP, the first president of the newly formed academic medical group. Dr. Moseley will assume the new position on April 11, 2022.

Kelly Foster, a medical oncologist specializing in breast and gastrointestinal cancers, has joined Tampa General | Cancer Center of South Florida in Palm Beach County. Before moving to Florida, Foster was a medical oncologist at Northwestern Medicine in Chicago.

Modern Healthcare has named Tampa General Hospital President and CEO John Couris one of the Top 25 Innovators in 2022.

— FOR YOUR RADAR —

Aside from coverage by Florida Politics, these stories are worthy of your time.

—”Nursing home care, funding system need overhaul, report says” via Matt Sedensky of The Associated Press — Nursing home residents are subjected to ineffective care and poor staffing, while facility finances are shrouded in secrecy, and regulatory lapses go unenforced, according to a recently released report that called for wholesale changes in an industry whose failures were spotlighted by the pandemic.

—”Florida health system will pay $20M to resolve false claims case” via Ayla Ellison of Becker’s Hospital Review — Clearwater-based BayCare Health System has agreed to pay the U.S. $20 million to resolve allegations that it violated the False Claims Act, the Justice Department announced April 6. The settlement resolves allegations that the health system made donations to the Juvenile Welfare Board of Pinellas County to improperly fund the state’s share of Medicaid payments to BayCare.

—”New CEO takes reins at HCA Florida Citrus Hospital” via Fred Hiers of the Citrus County Chronicle — It was decades between Lisa Nummi starting her career as a bedside nurse and becoming the CEO of HCA Florida Citrus Hospital last month, but she said her focus is the same: the care of patients.

—”Filling the doctor gap will require a range of responses” via Amy Kellor of Florida Trend — While there’s general acknowledgment that increasing the number of residencies in the state is key to addressing the shortage of physicians, the profession hasn’t always been eager to expand the ranks of physicians.

—“Community advocates have worked tirelessly to close the Latino vaccination gap. It’s working” via Melissa Feito of WUSF News — At the beginning of the vaccine rollout in 2021, data show Latinos lagged behind Whites in vaccination uptake. In Florida, that trend is reversing, with Latinos now taking the lead.

— PENCIL IT IN —

Tuesday

11 a.m. The Florida Department of Health/Division of Community Health Promotion meets with the Information Clearinghouse on Developmental Disabilities Advisory Council to advise the Department of Health on establishing and maintaining a clearinghouse of information related to developmental disabilities on its website. Meeting link here. Or call (850) 792-1375; participant code: 280684523#.

Wednesday

8 a.m. The Board of Respiratory Therapy Probable Cause Panel meets. Call (888) 585-9008; participant code 564341766.

8:30 a.m. The Florida Board of Pharmacy meets. Place: Hilton University of Florida Conference Center Gainesville, 1714 SW 34th Street, Gainesville.

2:30 p.m. The Florida Health Insurance Advisory Board meets. Call (866) 299-7949. Code: 1433866.

Thursday

10 a.m. The Substance Abuse and Mental Health Program meets in Duval County for a quarterly meeting. Place: Department of Children and Families, Northeast Regional Office, 5920 Arlington Expressway, Jacksonville.

3 p.m. The Florida Coordinating Council for the Deaf and Hard of Hearing meets. Meeting link here. Or call (888) 585-9008, participant code: 828532954.

— HAPPY BIRTHDAY —

On Wednesday:

Happy Birthday, Chief Financial Officer Jimmy Patronis

Happy Birthday, Rep. Sam Killebrew

Happy Birthday, Rep. John Snyder