- Abby Goodnough
- Aetna Better Health of Florida
- Agency for Health Care Administration
- Ashish Jha
- Caroline Catherman
- Chris Sprowls
- Christopher O’Donnell
- Cindy Krischer Goodman
- Community Care Plan
- Courtney Bovee
- David A. Eichenbaum
- David Schutz
- Florida Association of Health Plans
- Florida Board of Massage Therapy
- Florida Department of Transportation
- Florida Mental Health Advocacy Coalition
- gender dysphoria
- Grethel Aguila
- Humana Medical Plan
- Jack Capra
- Joe Biden
- Joseph T. Nezgoda
- Karen Murillo
- Luxme Hariharan
- Medicaid Medical Care Advisory Committee
- Molina Healthcare of Florida
- Raquel Goldhardt
- Simply Healthcare Plan. Inc.
- Sunshine Health Plan
- The Florida Alliance of Home Care Services
- The Florida Association of Community Health Centers
- The Florida Association of Managing Entities
- The Florida Democratic Party
- the Florida Dental Association
- The Florida Hospital Association
- the Florida Medical Association
- Zayne Smith
- Zelia M. Correa
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Florida Medicaid agency officials have scheduled a two-hour public meeting on July 8 to discuss a proposed ban on Medicaid coverage of gender dysphoria in Florida.
Anticipating that the proposed changes could draw a crowd, the Agency for Health Care Administration opted to hold what could be the only public meeting in the auditorium of the Florida Department of Transportation building instead of its headquarters.
The proposed amendment published by the Ron DeSantis administration last week would add language to an existing Medicaid rule that bans Medicaid from providing coverage for gender dysphoria. It excludes coverage of puberty blockers, hormones and hormone antagonists, sex reassignment surgeries, and other procedures that alter primary or secondary sexual characteristics.
Moreover, the proposed language bans physicians from considering dysphoria and gender-affirming treatment when determining what’s “medically necessary” for their patients.
The administration is moving to alter the state policy by amending a rule that applies to all Medicaid-participating providers. The underlying rule allows providers to limit the number of Florida Medicaid recipients they treat but makes clear that hospitals cannot refuse to provide emergency care, and providers are precluded from denying services based solely on “race, creed, color, national origin, disabling condition or disability, in accordance with federal anti-discrimination laws.”
If successful, gender dysphoria would be the only diagnosis in the rule for which treatment is banned. But Florida does limit other Medicaid coverage in the rule. For instance, the regulation prohibits Medicaid from providing coverage for people in prison. The rule also makes clear that “aliens” qualify for “emergency” Medicaid services, but once the emergency no longer exists, Medicaid stops providing coverage.
The meeting starts at 3 p.m. and ends at 5 p.m.
I welcome your feedback, questions, and especially your tips. You can email me at [email protected] or call me at (850) 251-2317.
— Medicaid procurement heats up —
There are signs that work on the state’s Medicaid managed care procurement is beginning.
Three medical care advisory subcommittees are scheduled to meet this week — two of the committees address children’s health care issues, and the third committee will discuss mental health and substance abuse issues. A long-term care committee met last week. The subcommittees are part of a larger medical Care advisory Committee that is required to meet by federal law.
AHCA also made available this week the responses to its request for Information soliciting input on ways the state’s Medicaid managed care program could be improved before the state issues its next solicitation.
The responses are available here, with a summary of responses below ….
— Managed care plans say —
Florida Association of Health Plans wants the state to streamline the collection of quality metrics like how Medicare measures quality metrics and explore “alternatives to liquidated damages for quality metrics.”
Aetna Better Health of Florida, Inc. asked the state to work with managed care plans to identify opportunities to reinvest any savings into the Florida communities.
AmeriHealth Caritas Florida identified several opportunities for AHCA to reduce the administrative burden for the plans, providers, and the state by eliminating the mandatory site visits for every primary care physician every three years. “Other states have removed this requirement from their Medicaid program, as it creates an undue administrative burden on the provider offices (that) must accommodate this request from every plan with whom they contract,” the plan wrote in its response. Additionally, the plan said the accuracy of enrollee information needs to be improved: “There is significant waste of financial resources and time as well as lost opportunity associated with failed attempts to contact enrollees that is caused by inaccurate enrollee contact information.”
Community Care Plan suggested that the state alter the current auto-assignment algorithm to reward plans with higher HEDIS quality scores to receive preferential auto-assignment. It also recommends requiring enrollees to provide their preferred communication method (by phone, text, email, or postal mail) at the time of application. The health plan also recommended allowing plans to ask members for a preferred method of communication in addition to the contact information.
Humana Medical Plan was the only plan to submit a redacted response. In its response, the health plan recommended that the state allow contracted health plans to telehealth to address network adequacy issues and “to provide critical support services to low-risk recipients or those needing follow up.”
Molina Healthcare of Florida said the state should require managed care plans to describe and submit community engagement plans as part of the next contract procurement. The community engagement plans mitigate the social determinants of health care barriers that contribute to health disparities and prevent economic self-sufficiency at the community level and individual member cohorts. The health plans also recommended that AHCA require managed dental plans to send monthly files to the medical managed care plans showing the primary dentist assigned to each child and adolescent member.
Simply Healthcare Plan. Inc. said in its submission that doula services have been vital in narrowing the gap in birth outcomes for minority women: “We, therefore, recommend that doula services be considered as a fully covered, core benefit to ensure all plans provide doula care coverage.” Simply also wants AHCA to expand the scope of services specialty plans can offer to include traditional managed medical assistance and long-term care benefits similar to a comprehensive plan. “This would enable a member in such a plan to have all their needs met by one plan including (long-term care) services.”
Sunshine Health Plan said the state should implement and maintain a single, payer-agnostic electronic prior authorization (PA) submission solution. The plan also recommends that the state require managed care plans to hire Florida-based provider-engaging staff in each region they are authorized to operate to understand better the unique challenges providers and members face within their communities. Additionally, the plan recommends that plans be required to share a standard set of health information, including the historical member profile, open authorizations, and providers seen in the last six months as members transition from health plans.
— Medical, hospitals, dental associations say —
The Florida Medical Association thinks the state should require all contracted Medicaid managed care plans that have had contracts for two years to reimburse all physicians at the Medicare rate. New entrants into the Medicaid managed care marketplace would have two years before they would be required to reimburse physicians on their panels at the Medicare rates. In its response, the group representing doctors also says the agency can enforce the increased payment under current law.
The Florida Hospital Association wants the state to require contracted managed care plans to adopt a maternity medical home model for high-risk mothers. The FHA said in its response that it also wants the agency to adopt parity patent policies to support the insinuation of telehealth.
The Florida Dental Association wants the state to use a special identifier for patients with special health care needs who are likely to require anesthesia/sedation for any dental service. The FDA said in its response that to provide those services, dentists need access to ambulatory surgical centers and hospitals for sedation services and that the contracted medical plans should help dentists leverage access to those spaces.
— Mental health and substance abuse providers say —
The Florida Behavioral Health Association wants the state to get approval from the federal government to implement what is known as the Community Certified Behavioral Health Clinic (CCBHC), which provides for future payments to CCBHC-designated providers. Moreover, the group wants the state to “direct’ the Medicaid managed health plans to contract with CCBHC providers once the CCBHC program is implemented; there are 13 CCBHC grant awardees in the state and another 33 providers recently submitted grant applications for CCBHC funding.
Florida Mental Health Advocacy Coalition wants the plans to train employees who field phone calls about the nature and treatment of protocols for treating people with serious mental illness according to its response.
The Florida Association of Managing Entities wants managed care plans to contract with managing entities for best practice programs for pregnant and postpartum women, special prenatal care to mothers, children/adolescents, families, adults and senior models, homeless, veterans, diversion and hospital bridge, respite, integrated care, and smart justice.
— More thoughts from other providers —
The Florida Alliance of Home Care Services wants the state to add a consumer price increase to deliveries of durable medical equipment services. The group also wants the durable medical equipment industry to have a representative on the Medicaid Medical Care Advisory Committee.
The Florida Association of Community Health Centers wants the state to recognize federally qualified health centers, which provide care to one-in-seven Medicaid enrollees, as essential providers for the upcoming procurement.
The Home Care Association of Florida said that home health care providers are paid on outdated fee-for-service fee schedules, and that managed care plans are not paying providers within 120 days as required by law.
The Florida Hospice & Palliative Care Association suggested that managed care plans be required to “accept the patient’s choice for hospice provider and contract with that hospice to provide the Medicaid room and board portion of the service.”
— RULES —
The Department of Health proposes developing Rule 64J-1.024 to establish disciplinary guidelines for the professions of emergency medical technician, and paramedic, licensed emergency medical services providers, and EMT and paramedic training programs to clarify the range of discipline. More here.
AHCA proposes amending Rule 59A-36.021 regarding licensure of assisted living facilities and the Florida Building Code. More here.
AHCA proposes amending Rule 59A-36.012 regarding the responsibilities for food service standards within assisted living facilities. More here.
— ROSTER —
— AARP Florida’s Zayne Smith has been promoted to director of Advocacy. Karen Murillo joins AARP as the association’s Advocacy Manager. Murillo is a former Assistant Statewide Prosecutor for the Attorney General’s Office.
— Joseph T. Nezgoda, M.D., MBA, was installed as president of the Florida Society of Ophthalmology (FSO) Nezgoda is a former researcher at the world-renowned National Institutes of Health. He graduated with honors from Georgetown University and attended medical school at Rutgers (UMDNJ)-Robert Wood Johnson Medical School, where he received the Excellence in Teaching and Gold Humanism Awards. He trained at Mount Sinai (New York), Einstein Medical Center, the Cleveland Medical Center, and the University of California. He focuses on macular degeneration, diabetic eye disease, and other serious blinding eye diseases. He practices in West Palm Beach, Delray Beach and Boca Raton. Tampa ophthalmologist David A. Eichenbaum, was installed as president-elect.
— Raquel Goldhardt, Zelia M. Correa, Luxme Hariharan and Courtney Bovee, were installed as the vice president of Advocacy, vice president of education, vice president of outreach, and secretary/treasurer, respectively.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— Another VAX dust-up: Florida doctors and hospitals can order COVID-19 vaccines for children under 5, now that the federal government has given its initial OK to the shots, but the state won’t be ordering any vaccines for county health departments. Florida was the only state that did not pre-order the vaccines for children. White House Coronavirus Response Coordinator Ashish Jha told reporters that Florida has now ordered vaccine doses designed for children. The federal government said the DeSantis administration reversed its policy, but the DeSantis administration denied that was the case noting that the plan always was for health care providers to place their orders, which they can now do.
— No love for Tally: Florida’s top IT officer says getting talented senior-level IT staff to work for the state of Florida is an uphill battle, and he named low wages as well as living in Tallahassee, the state capital that is hundreds of miles away from the state’s major metro areas, among the top reasons.
— Up, up, up: The number of complaints concerning Florida’s Medicaid managed long-term care program has risen recently. Paula James, the AHCA administrator for the Bureau of Plan Management Operations, presented data showing 312 calls in May complaining about the contracted managed care plans that provide long-term care services in the state.
— Opportunities: Within DeSantis’s budget approved earlier this month, the Legislature submitted a Local Support Grants Program, effectively extending the appropriations project request period into the summer months. In a memo to House members on Monday, Speaker Chris Sprowls briefed members on how they can seek funding for the initiatives of local governments, education entities, and privately operated programs in their districts. Lawmakers will pay for the projects with $175 million in federal stimulus cash received through the Federal Coronavirus State Fiscal Recovery Fund, made available by President Joe Biden and Democrats in Congress.
— RIP: Jack Capra, Interim General Counsel at the Department of Elder Affairs (DOEA) and a U.S. Navy veteran who served alongside Gov. Ron DeSantis in Guantánamo Bay, died. Capra and his service dog, Rocco the black labradoodle, were well-known in government circles. In addition to his service, Capra was an advocate for service members and service dogs, including as an early graduate of K9s for Warriors.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
—“There’s a health gap in South Florida’s Black communities. Here’s what can be done” via Grethel Aguila of the Miami Herald — When Melida Akiti’s son-in-law suffered from severe abdominal pain, he trudged over to urgent care. He checked in and waited, only to be discharged with nothing but Tylenol. The experience is why he — and many other people of color — hate hospital visits. At midnight, he called Akiti, a vice president at Memorial Healthcare System, in excruciating pain. She took him to the same urgent care center and demanded to know why the staff ignored his ailments. Then the matter was taken seriously — seriously enough to hospitalize him for four days. He could have died without treatment.
—“Florida surpasses 75,000 COVID-19 deaths; two-thirds of state in high-risk category for community spread” via David Schutz and Cindy Krischer Goodman of the South Florida Sun-Sentinel — Florida reached a grim milestone this week: More than 75,000 people in the state have died of COVID-19. The new death toll comes as COVID hospitalizations are rising to levels last experienced during Florida’s winter surge and two-thirds of the counties in the state — including South Florida’s three counties — have moved into the red zone for elevated risk of community spread. Over the past two weeks, another 506 COVID-related deaths were reported in Florida and more than 300 were admitted to Florida hospitals with the virus, an indication that some Floridians are at substantial risk from the omicron strains now circulating.
—“Patient death spurs Orlando Health nurses to sound alarm about staffing” via Caroline Catherman of the Orlando Sentinel — The suicide of a patient at Orlando Regional Medical Center last month has fueled unrest among nurses about what some describe as severe understaffing at the hospital, though a state review found the facility was not at fault for the death. On May 27, a TikTok user known as Nurse Nander posted a video sharing several widely percolating rumors, including that short-staffing contributed to the May 16 suicide — in which a patient broke open the window of his eighth-floor room and jumped to his death. In the following weeks, the video garnered over 1.5 million views. Comments about short staffing and poor working conditions at Orlando Health poured in from dozens of users who claimed to be employees.
—“Florida health officials warn of growing meningococcal outbreak” via Christopher O’Donnell of the Tampa Bay Times — State health officials are warning the public about a rise in the number of statewide cases of meningococcal disease. However, there are few cases in the Tampa Bay region. The disease first appears as a flu-like illness, with fever, headache and a stiff neck, and rapidly worsens, according to the Centers for Disease Control and Prevention. The two most common types of meningococcal infections are meningitis and septicemia, both of which can be deadly in a matter of hours. In meningitis, bacteria infect the lining of the brain and spinal cord and cause swelling.
—“Inside one abortion clinic, signs of nationwide struggles” via Gabriela Bhaskar and Abby Goodnough of The New York Times — At a Planned Parenthood health center on Florida’s Gulf Coast, new restrictions on who can get an abortion are shaking up routines and creating challenges for the clinic’s patients, doctors and nurses. The center in Fort Myers had seen a steady influx of patients from Texas since last September when a ban on all but the earliest abortions took effect there, and from other states that have tightened access to the procedure over the past year. It is also adjusting to a waiting period that took effect in Florida in April after years of litigation, requiring patients seeking an abortion to have an ultrasound and then wait at least 24 hours before returning for the actual procedure.
— PENCIL IT IN —
Happy birthday to Reps. Chuck Clemons and Linda Chaney.
11 a.m. The Florida Democratic Party press availability on the DeSantis administration’s decision not to pre-order child vaccines.
2 p.m. The Medicaid Medical Care Advisory Committee (MCAC) Subcommittee for Behavioral Health/ Substance Use meets. Meeting link here. Email [email protected] for a copy of the agenda.
Happy birthday to Rep. Daniel Perez.
9 a.m. The Florida Board of Massage Therapy meets. Call (877) 309-2073; participant code: 985532741.
Happy birthday to Rep. Joy Goff-Marcil.
10 a.m. The Medicaid Medical Care Advisory Committee for Children and the state Foster Care System meets. Meeting link here. Email Timo [email protected] for a copy of the agenda.
1 p.m. Medicaid Medical Care Advisory Committee (MCAC) Dental Subcommittee meets to discuss dental care for children. Meeting link here. Email [email protected] for a copy of the agenda.
Happy birthday to Rep. Bryan Avila.
Happy birthday to First Lady Casey DeSantis, as well as Reps. Mike Beltran, Dianne Hart and Lawrence McClure.
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