Diagnosis for 5.2.22: 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‘ announcement last week that state legislators are coming back to the state Capitol for a Special Session dealing with property insurance probably pushes back the moment of reckoning for tens of millions of health care funding spread throughout the $110 billion budget.

Legislators voted for the budget back in March, but they have yet to send the spending blueprint for the next fiscal year to the Governor. The Governor will likely act very quickly once it officially lands on his desk, but it would be unusual for him to hand out a bunch of budget vetoes just days before lawmakers are about to gavel in for a new session. Legislative relations 101 would dictate that the Governor would want to wait to see what legislators do during this next session before making a final decision on the budget.

DeSantis’ proclamation set the dates of the special session to run from May 23 to May 27. The new budget covers spending from July 1, 2022, to June 30 of next year. In the years when legislators hold Sessions in March and April, it’s not unusual for budget vetoes to come rolling in sometime around Memorial Day.

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— Did someone say veto? —

Targeting a budget item as a “turkey,” a Tallahassee-coined term for special projects that sounds nicer than pork — a bit more art than science.

Florida TaxWatch released its annual Budget Turkey Watch Report and the latest edition listed 166 projects in the fiscal year 2022-2023 budget that the organization believes did not adhere to joint appropriations rules and require further scrutiny.

But this long $281 million list of “turkeys” includes just one health project: a $2 million project for Hernando County championed by Sen. Danny Burgess.

What’s not included on the Florida TaxWatch list is a $2 million appropriation for long-acting reversible contraception that was championed by Senate President Wilton Simpson. Lawmakers included funding for LARC in the so-called “sprinkle list” that was added to the budget in the last moments of negotiations March 9.

The issue had not been included in either chamber’s initial budget. It also was not, and it was not considered by spending panels.

In explaining the omission of the LARC funding from the turkey report Kurt Wenner, senior vice president of research for Florida TaxWatch, told Florida Politics that the $2 million directed for LARC funding wasn’t a member “appropriations project,” as defined by the joint rules.

Wenner also noted that Lawmakers included $2 million for LARC in the FY 21-22 budget. Despite being a priority for Simpson, though, Gov. Ron DeSantis vetoed the spending item. DeSantis is being urged once again to veto the funding.

— Not quite ‘turkey’ —

Though not identified as “turkeys” because the appropriations rules were followed, Florida TaxWatch also recommended that the Governor provide special scrutiny to a number of other budget projects, including providing funding to private organizations and local governments for improvements to facilities that the state does not own.

TaxWatch estimates that legislators agreed to spend nearly $159 million for capital improvements at 64 facilities that are not owned by the state — a fact that has prompted budget vetoes by other Governors in the past. Examples include $80 million for the Leon Haley Jr., M.D. Trauma Center in Jacksonville; $10 million for Tampa General Hospital Global Emerging Disease Institute; $5.39 million for Special Hearts Farm; $3.9 million for the Hialeah Housing Authority; $2.5 million for the K9s for Warriors Center for Operations and Training; and $1.3 million for the Miami Learning Experience School-Adult Program.

The projects are scattered across the various health care agencies. The Department of Children and Families has about $33.7 million in capital outlay funds for 28 capital improvement projects for non-state-owned facilities. The Department of Health has more than $101 million in capital outlay funds for 12 projects, $90 million of which is spent on the two hospital projects.

“There are millions of dollars in the budget for member projects for private organizations and local governments to construct, renovate, repair, or even purchase buildings/facilities the state does not/will not own,” the report notes. “Governors have vetoed some of this fixed capital outlay spending, citing that local government facilities are a local responsibility and there is no clear statewide return on investment for constructing, maintaining, or renovating privately-owned facilities.”

— Tick, tick boom —

Time is running short for a Destin nursing facility to transfer its residents and close its doors.

Agency for Health Care Administration Communications Director Brock Juarez told Florida Politics that by the end of the weekend, 99 residents of the Destin Healthcare and Rehabilitation Center will have been transferred from the nursing facility.

AHCA did not answer whether all the residents had been transferred to another nursing home or if some chose to not remain in institutional care.

According to the Agency for Health Care Administration Deputy Secretary Kimberly Smoak there were not enough available vacant nursing home beds in Okaloosa County where the Destin nursing home is located to accommodate all the residents that needed to be transferred. That means some residents had to be transferred to facilities outside of the county.

But Juarez did not provide Florida Politics with the names of the counties where the residents were being transferred at press time.

Smoak issued an emergency order April 16 suspending the facility’s license effective April 25 at 5 p.m. She also ordered the transfer of more than 100 residents to different facilities. The emergency order came after the agency discovered that the facility continued to accept new nursing home residents despite being understaffed.

Smoak issued a second order April 22 giving the nursing home until May 2 at 5 p.m. to have the residents transferred.

In the second order, Smoak ordered the facility to report to provide daily status reports to the state with the names of the residents, the names and location of the entities the residents were discharged to, the date and time of the discharge, and the name of the residents’ treating physician and caregiver. Smoak said she was granting the extension because protective measures had been put into place to ensure the residents were not in danger.

— Hoping for Hope Squad? —

Members of the Florida Children and Youth Cabinet were pitched last week on the merits of Hope Squad, a school-based peer-to-peer suicide program that is up and running in 35 states and currently is operational in 27 different Florida schools.

It initially made its debut in schools in Alachua and Okaloosa County, according to United for a Good Cause Executive Director Peggy Brockman, who attended the meeting and touted members about the program. Brockman told the cabinet member that Hope Squad’s success lies in its unique approach to suicide prevention and education. In addition to being a peer-based approach, where students confide in other students, it’s the student body, not the administration or teachers, which chooses which students will serve as Hope Squad members. The program creates a safer school environment; encourages mental wellness; reduces the stigma around mental health and aims to prevent substance use disorders.

There is a sliding scale fee for the program curriculum with high schools initially paying about $8,000 to launch the Hope Squad. That fee covers the costs of a four-year curriculum, which is $6,000, as well as the training and certification of four “advisers.” There is an adviser, who must be a school employee, for each grade level and training, the cost for each adviser is $500.

High schools must pay $500 annually to keep the program after four years.

The cost structure is similar for middle schools, but the curriculum is $5,400 because it’s just for three years. The annual fees and the training costs are identical to those paid by high schools. The curriculum is approved for grades 4 and up; it’s also available to elementary schools.

United for a Good Cause has raised money to cover the costs of the suicide prevention program for district schools in Okaloosa County and in the coming year will cover the costs to bring the program to district schools in Escambia and other neighboring counties.

— Splurging —

U.S. Rep. Stephanie Murphy is holding a ceremony today to note $400,000 in new federal funding that is going to the Sanford-based Hope & Healing Center, a joint partnership between AdventHealth and the Seminole County Sheriff’s Office. The Center assists individuals struggling with opioid addiction, especially low-income individuals, and those without health insurance.

Murphy will be joined by Seminole County Sheriff Dennis Lemma and Tim Cook, the CEO of AdventHealth’s Seminole County market.

The money is coming from the consolidated appropriations act, a $1.5 trillion spending bill for the year that was approved and signed into law by President Joe Biden in March. And the money for the opioid treatment center isn’t the only Florida health care project in line for funding.

Some of the other health-care-related projects in the federal spending bill include $7.65 million to Mt. Sinai Medical Hospital in Miami-Dade County to help with resiliency efforts; $2 million for the Florida International University PET/Cyclotron Center; $250,000 to purchase a mammogram machine for the primary care medical clinic at 26 Health Inc., a nonprofit organization in Orlando; $562,385 for the Broward County Mental Health Diversion Project; $646,762 for a suicide prevention program at United Way of Broward County in Fort Lauderdale; $385,848 for Rales Jewish Family Services in Boca Raton for tele-mental health services; and $2 million for the mental health collaborative project between Premier Community Health Center and Community Health Centers of Pinellas County.

— RULES — 

The Board of Medicine proposes amending Rule 64B8-14.002 to update the rule text to remove abbreviations and definitions no longer used. More here.

The Board of Medicine proposes amending Rule 64B8-15.001 to clarify and update the rule text and update specific reference material. More here,

The Board of Medicine proposes amending Rule 64B8-9.0091 to add and accredit organizations approved by the Board into the rule. 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.

— “Racist attitude“: Janet Cruz contends that racism has played a role in the state’s decision not to expand the nation’s health care safety net program to low-income, childless adults as allowable under federal law. “In my opinion, it is indeed a racist attitude to think that the poor don’t deserve health care. It’s not a privilege. Health care is not a privilege. It should be a basic right,” the Tampa Democrat said on a conference call to discuss Medicaid expansion set up by the Democratic Legislative Campaign Committee.

— Wait for it: After a five-year wait, it’s still unclear when a decision will be made on which Black farmer applicant will get a license. The Florida Department of Health’s Office of Medical Marijuana Use was accepting, between March 21 and March 25, applications for new medical marijuana licenses. But the DOH won’t say how many applications were received. It also will not make the applications available for the public to review.

— Hacked: Tenet Healthcare Corporation announced it was investigating a “cybersecurity incident” that impacted two of its Florida hospitals. In a statement, the Dallas-based company acknowledged there was a “temporary disruption to a subset of acute care operations,” but added that the company’s hospitals remained operational. “At this time, critical applications have largely been restored and the subset of impacted facilities (have) begun to resume normal operations.”

— That’s a lot of infections: As the omicron variant swept across the United States, the number of COVID-19 infections reached an all-time high. A Centers for Disease Control and Prevention (CDC) report shows the extent to which the percentage of people with COVID-19 antibodies rose as well. Nearly 58% of the overall population had evidence of the antibodies associated with the disease that has killed nearly 1 million people in the United States and nearly 74,000 in the state of Florida. The data from February 2022 showed the percentage of young children and adolescents who had the antibodies was even higher, reaching 75%.

— Kudos: Trulieve CEO Kim Rivers has won the Green Market Report Women’s Leadership Award in the C-Suite category. The Green Market Report is a publication that focuses on the financial news of the rapidly growing cannabis industry. Its Women’s Leadership Awards are meant to honor women and female-identifying cannabis professionals. Other award categories included Activism/Politics, Social Equity, Cultivation, and Media.

— ROSTER —

Cleveland Clinic Martin Health welcomes board-certified maternal-fetal medicine specialist, Kathleen Berkowitz, M.D. She previously served as the vice-chair of the Department of Obstetrics and Gynecology at Cleveland Clinic Fairview Hospital before joining Cleveland Clinic Martin Health.

Interventional Cardiologist, Dr. Augusto Villa was named medical director of the Robson Heart & Vascular Institute’s Structural Heart Program at Jupiter Medical Center.

Americans for Prosperity-Florida named Carrie Patrick previously worked for former Govs. Jeb Bush and Charlie Crist, and also worked at CoreMessage and, most recently, The GTM Group.

— FOR YOUR RADAR —

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

—”Medicaid Awareness Month: Stories highlight how Medicaid helps Floridians” via Miriam Harmatz, Advocacy Director & Founder, Florida Health Justice Project — The Florida Health Justice Project is sharing the lived experiences of parents explaining why “Medicaid is a blessing” and why they “cannot live without Medicaid.” These short personal videos cover the gamut of parental experiences, including the voices of parents whose children have complex medical needs.

—”Florida lost 70,000 people to COVID. It’s still not prepared for the next wave” via Arek Sarkissian — As COVID infections begin creeping up again across the country, current and former health officials in Florida are warning that the state remains woefully underprepared to handle the next wave of the pandemic.

—“Former Florida Surgeon General disputes state’s vaccine, transgender guidance” via Kirby Wilson of The Tampa Bay Times — Scott Rivkees, the first Florida surgeon general appointed by DeSantis, does not seem to agree with recent guidance from the department he once ran. The Department of Health, which is now run by Surgeon General Joseph Ladapo, issued guidance in March discussing the potential dangers of giving healthy children COVID-19 vaccines. This month, the Department of Health put out a statement advising against social transition or gender-affirming surgery for transgender children. Rivkees, who has since left the state to take a job at Brown University, publicly disputed both of those stances recently.

—”Florida program that shirked duty to help kids with brain injuries could face a costly reckoning” via Daniel Chang and Carol Marbin Miller of the Miami Herald — For years, a Florida program that pledged to pay the health care costs of children who suffered catastrophic brain injuries at birth has been saving millions of dollars by shifting the costs to taxpayers. The tab was supposed to be picked up by the program using a pot of money fed with fees paid by doctors and hospitals but instead was billed to taxpayer-financed Medicaid. Now the bill for that financial sleight of hand may come due. The 11th U.S. Circuit Court of Appeals ruled that a whistleblower lawsuit challenging the longtime policy of Florida’s Birth-Related Neurological Injury Compensation Association, or NICA, can move forward.

—”Memorial Healthcare chooses new CEO” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — The board of Memorial Healthcare System, which operates five adult hospitals and a children’s hospital in south Broward, has chosen a top candidate to become its new leader. The board voted Friday night to extend an offer to Scott Wester to take the helm of Memorial Healthcare System, a publicly funded health system also known as the South Broward Hospital District.

— PENCIL IT IN —

Tuesday

11 a.m. The Physician Workforce Advisory Council meets to discuss the current and future physician workforce needs in this state. Meeting link here. Or call (850) 792-1375; participant code 37910573. Contact Nathan Dunn at (850) 245-4018 for a copy of the agenda.

Wednesday

Happy birthday, Sen. Tina Polsky.

Friday

National Nurses Day

9 a.m. The Board of Clinical Laboratory Personnel meets. Hilton Garden Inn; 11400 Marbella Palm court; Orlando. Agenda here.

3 p.m. The Board of Medicine Probable Cause Committee North meets to discuss cases where probable cause has been found. Meeting link here.