Diagnosis for 7.18.22: 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.

Florida Democrats gathered in Tampa over the weekend for their annual Leadership Blue convention.

And while health care was not a primary focus, it was still a central talking point — especially regarding abortion and the Supreme Court decision reversing the 50-year-old Roe v. Wade ruling.

Rep. Charlie Crist, who is running for Governor, also rolled out a significant insurance idea that would affect the state’s group health insurance plan.

As part of his “Freedom to Learn” proposal, Crist called for opening the $3.1 billion program to schoolteachers and school district employees across the state. However, Crist said the trade-off would require participating school districts to take the savings and use that money to pump teachers’ salaries.

Crist’s plan could require a substantial bump in state funding depending on how many districts choose to embrace the concept.

The recurring topic for Democrats was abortion. A panel of Black Democrats led by Sean Shaw, whose father penned a state Supreme Court ruling that maintained Florida’s privacy clause bars strict abortion restrictions, expressed fears that a clampdown on abortion rights would affect communities of color significantly because women would be unable to travel outside the state to seek services.

Aramis Ayala, a candidate for Florida Attorney General, also expressed concerns about whether health care providers, including obstetricians and gynecologists, would be targeted because of abortion restrictions. Under Florida’s new law, physicians can be charged with a third-degree felony if they perform an abortion after 15 weeks of pregnancy. Ayala said that while the focus to date has been on pregnant patients, doctors also need protection — if they are prosecuted, women won’t be able to access abortions.

Senate Democrats also held a near-hour roundtable on reproductive freedom. Moderated by Senate Minority Leader Lauren Book, the message was clear: Democrats on the stump are making reproductive rights an issue. Book noted that matter isn’t only for women; male candidates must also bring their game.

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— Hospice is hot —

The state’s preliminary decisions to award a hospice program in one county and deny a program in another are being challenged in state administrative court.

Three different hospice providers recently notified the state they were challenging the decision to award a certificate of need (CON) to Affinity Care of Charlotte and De Soto LLC. Two challengers are providers seeking to put their hospice facility in Charlotte County: Florida Hospice, LLC, and Vitas Healthcare Corporation of Florida.

Empath Tidewell Hospice, the existing hospice provider in Charlotte County, also filed notice with the state that it was challenging the decision to award the CON to Affinity Care of Charlotte and De Soto LLC.

Empath opposed bringing an additional hospice into the area. An AHCA analysis of the three CON applications shows that Empath Tidewell opposed a new hospice program and noted that the agency did not publish a need for an additional hospice in the area.

The challenges will be heard in the state administrative court. At press time, no hearing date had been set.

Hospice care is provided to people who are nearing the end of life. The goal is to maximize comfort and ease treatment for underlying medical conditions causing death. Hospice services are provided by a team of health care professionals led by a physician. Medicare, Medicaid, and commercial health insurance provide coverage for hospice care. CON is a regulatory process where the state attempts to ensure high-quality health care and control the costs by limiting the proliferation of services. While the state eliminated CONs for hospitals, it still relies on the licensure program to regulate hospice, nursing homes, and intermediate care facilities for the developmentally disabled.

The tentative decision in Charlotte has drawn many challenges, but a decision in Palm Beach County has drawn just one. Palm Beach County Seasons Hospice & Palliative Care of Palm Beach County, LLC, is challenging AHCA’s decision to deny it a CON.

No notice of challenge was filed to the state’s decision to award a CON to Gulfside Hospice, Inc., which wants to open a 24-bed inpatient hospice facility in Pasco County.

Gulfside, which has been providing hospice services in the area for 32 years, anticipates finishing construction on the 23,469-square-foot building in December 2023 and will begin offering care on Jan. 1, 2024.

According to a review of its CON application, the new project is estimated to cost more than $13 million. More than half of those costs, or $7,890,400, are attributable to construction

— Vitas Healthcare Medicare audit —

In more hospice news, a federal audit of Vitas Health Corporation of Florida indicates that the hospice provider received “at least $140 million in improper Medicare reimbursement” for hospice services provided between April 2017 and March 2019.

The Department of Health and Human Services Office of the Inspector General has recommended that Vitas refund to the federal government the portion of the overpayments for claims that are within the 4-year claims reopening period and strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

For its part, Vitas disputes the findings, noting in a 22-page response that the OIG’s performance audit failed to adhere to applicable laws and standards of professional practice.

“The draft report is disappointing and at odds with Vitas’s history, leadership, policies and procedures, and culture of compliance,” Bryan K Nowicki, an attorney with Husch Blackwell, wrote in response. He also noted that if it were accurate, the $140 million overpayment amounts to “over one-half the total amount billed by Vitas for such care during that two-year period.”

The Medicare hospice benefits approved in 1982 allowed four levels of hospice care: routine home care, inpatient respite care, general inpatient care and continuous home care.

Conducted by the Department of Health and Human Services Office of the Inspector General, the audit covered 50,850 claims for certain services provided during the two years.

Auditors evaluated a sample of claims for compliance. According to the report, medical records associated with the sample claims were sent to an independent medical review contractor who determined whether the documents supported the billed hospice services.

The finds show that the company did not allegedly comply with Medicare requirements for 89 of the 100 sample claims reviewed. Twenty-seven of the claims reviewed contained more than one error. Specifically, for 68 claims, the clinical record did not support the hospice continuous home care level of care claimed for Medicare reimbursement. The clinical record did not support the general inpatient level of hospice care claimed in 28 claims. And 23 claims did not have documented support in the clinical record for continuous home-level care.

— D.C. fly In for children’s care —

Nemours Children’s Health sent a contingent of physicians to Washington last week to advocate for bipartisan legislation that increases funding for health care providers to expand mental health services for children and youth.

To that end, Nemours President and CEO Dr. R. Lawrence Moss, Executive Vice President Dr. Kara Odom Walker, Vice President Dr. Rachel Thornton, and Director of Child Health Policy and Advocacy Daniella Gratale met with U.S. Sens. Marco Rubio and Rick Scott. The Nemours’ contingent also met with U.S. Reps. Val Demings, John Rutherford and Darren Soto.

The Nemours leaders joined Children’s Hospital Association colleagues from across the nation for a fly-in to meet with congressional policymakers and highlight the urgent need to act on mental health before the August recess. The Children’s Hospital Association represents 220 pediatric facilities across the country.

They encouraged legislators to support the bipartisan Health Care Capacity for Pediatric Mental Health Act, which establishes three new grant programs at the Health Resources and Services Administration (HRSA) to support pediatric behavioral health care integration and coordination; workforce training; and investments in infrastructure. The legislation is sponsored by U.S. Sens. Bob Casey, a Democrat from Pennsylvania, and Bill Cassidy, a Republican from Louisiana.

— Getting the love —

AARP Florida State Director Jeff Johnson is thanking the Governor and AHCA Secretary Simone Marstiller for “elevating” the prescription drug issue.

Johnson said that AARP is committed to helping residents afford their medications at a recent news conference.

Big Pharma raised prices on more than 800 prescription medicines — and they have levied similar increases for decades, with no effective way to stop them from ripping off seniors,” he pointed out in a statement. “If consumer prices had risen as fast as drug prices over the last 15 years, gas would now cost $12.20 a gallon and milk would be $13 a gallon. Enough is enough.”

“We have more work to do at the state and federal level to help families struggling with the high cost of their medications. AARP Florida will continue to be a wise friend and fierce defender of Floridians 50-plus as we keep up the fight to lower Rx prices.”

Last week, DeSantis announced he was throwing his weight behind a requirement to limit pharmacy benefit managers and their “deceptive” pricing practices. DeSantis called PBMs a cottage industry, saying the pricing process is “so opaque you can see why money is potentially being skimmed.”

The EO applies to PBMs that have contracted with the state and subcontracted with entities that have contracts with the state. The EO specifically names AHCA, which is charged with the oversight of the Medicaid managed care program, and the Department of Management Services, which is charged with oversight of the state group health insurance program. The EO is silent on the Department of Health which is in charge of the Children’s Medical Services managed network.

The EO does not apply to PBMs for commercial health insurance (other than state employees). According to the Florida Office of Insurance Regulation, there were 3,807,574 people enrolled in commercial policies in 2020.

— ROSTER —

— Lee Health hired Dr. Jeffrey Innis as the hospital’s pediatric genetic specialist, announced in a news release. Innis graduated from the University of Miami School of Medicine with more than 35 years of experience with human medical and molecular genetics and is the region’s first pediatric geneticist. His practice will be based at Lee Physician Group Pediatrics — Coconut Point and Golisano Children’s Hospital of Southwest Florida. Before joining Lee Health, Innis was the chief of Pediatric Genetics, Metabolism and Genomic Medicine at the University of Michigan, where he also held a variety of other posts.

— Cheryl Wild is the new Chief Nursing Officer at HCA Florida Palms West Hospital in Loxahatchee. Wild earned a Bachelor of Science in Nursing (BSN) from Trenton State College in NJ and a Master of Nursing (MSN) in Health Administration from Drexel University in Philadelphia, PA.

— Former AHCA Secretary Rubén José King-Shaw was appointed to the board of directors of Steward Health Care, the nation’s largest physician-led health care network. King Shaw has served as the Executive Vice President and Chief Strategy Officer. Steward is an accountable care organization (ACO) with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through its network of hospitals, multispecialty medical groups, and urgent care centers, skilled nursing facilities and behavioral health centers. Former Gov. Jeb Bush appointed King-Shaw AHCA secretary in 1998. He left in 2001 for a post in the administration of President George W. Bush.

— ETC —

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

— Licensed nurse registries with Medicaid managed care contracts must be enrolled in the Florida Medicaid program to follow federal rules, AHCA announced in an alert Friday. To enroll in Medicaid, all providers must complete the Florida Medicaid provider enrollment process using the Online Enrollment Wizard. Meanwhile, nurse registries that provide home and community-based services to people in the Medicaid Budget program should contact the Agency for Persons with Disabilities before applying with AHCA.

— The DOH Division of Medical Quality Assurance has published its 3Q Performance Report for state fiscal year 2021-2022. Medical Quality Assurance regulates health care practitioners and facilities through professional licensure, facility permitting, and administrative enforcement to preserve the public’s health, safety, and welfare. The Quarterly Performance Report is required by law and includes information on revenue, expenditure, and performance measures.

— Another one … Borrowing a page from its Medicaid program, Florida is putting its $3.12 billion state group health insurance program out for a competitive bid in nine regions across the state. The Department of Management Services released three invitations to negotiate last week, advertising the need for third-party administrators to manage its HMO, PPO, and pharmacy benefits.

— And just one more … This could go down as the summer of the health care procurements. The Department of Health (DOH) issued a request for information asking interested parties to inform the state of ways to improve and supply information to help make an upcoming procurement of a Medicaid managed care program for medically complex children.

— Well done … The Georgetown University Center for Children and Families is awarding Tallahassee legal services lawyer Anne Swerlick its Bulldog of the Year Award. Georgetown CCF Executive Director Joan Alker announced the award at its annual conference Tuesday. The award recognizes someone who embodies the spirit of the university’s mascot, “Jack the Bulldog.”

— Back story … Vertos Medical, a medical device company, has dispatched a team of doctors and communicators to tour the East Coast, ending in Miami later this week at the conference of the American Society of Pain & Neuroscience, its partner in what they are calling the “Know Your Backstory” campaign.

— Pregnancy isn’t gender neutral … Gov. Ron DeSantis is joining the chorus of conservatives criticizing the use of gender-neutral terms like “birthing people” when describing pregnancies. Speaking in Putnam County on Thursday, Florida’s Republican Governor took the opportunity to opine on gender-neutral language when asked about implementing stricter anti-abortion laws.

— FOR YOUR RADAR —

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

—”Calls expected to surge with new 988 hotline. Florida centers are already strained” via Daniel Chang of the Miami Herald — “Florida’s mental health crisis call centers are gearing up for a surge in calls beginning on Saturday, when the National Suicide Prevention Lifeline switches to a new three-digit number for calls and texts, 988. The number is easy to remember in a crisis, and calls are expected to rise, challenging the capacity of Florida’s 12 national lifeline centers, which answer the third-highest call volume in the nation. A spike in calls and referrals for services will also test the abilities of Florida’s behavioral health services network; mental health advocates say because the resources to respond to such crises vary by county and region.”

—”Florida report on transgender care flawed, politically motivated, Yale experts say” via Christopher O’Donnell and Kirby Wilson of the Tampa Bay Times — A report from Florida’s Medicaid agency is anticipated to be the basis for a state rule banning the use of Medicaid to pay for hormonal therapies to treat transgender people diagnosed with gender dysphoria. It concluded last month that puberty blockers and other hormones are “experimental and investigational.” But a group of seven scientists and a Yale law professor are slamming the state report as unscientific, thoroughly flawed and politically motivated. An analysis published by the group this week highlighted what it says are significant deficiencies in the state’s 48-page report, which was released June 2 by Florida’s Agency for Health Care Administration.

—”COVID-19 update: Number of infected hospital patients rising fast with attention now on ICUs” via David Schutz and Cindy Krischer Goodman of the South Florida Sun-Sentinel — As the BA.5 strain of COVID-19′s omicron variant dominates the virus in Florida, hospital admissions are rising again, triggered mainly by people 60 and older. On Friday, more than 4,300 people with COVID-19 occupied beds in Florida’s hospitals, an 8% weekly increase and the highest number since mid-February.

—”Kids’ coronavirus vaccines are hard to find in Fla. Many blame DeSantis” via Lori Rozsa of the Washington Post — When coronavirus vaccines for infants and young children were authorized for the first time last month, Florida Gov. Ron DeSantis warned parents against the “baby jabs,” saying regulators had done insufficient testing and trials. Still, he said he wouldn’t stand in parents’ way if they chose to vaccinate their kids. “You are free to choose,” he assured them. Florida parents say it hasn’t turned out that way. Many are struggling to find places to vaccinate their children, and they blame DeSantis — noting he was the only Governor to refuse to preorder the vaccines and to prohibit county health departments from distributing or administering the shots. Waitlists at pediatrician offices stretch for weeks.

—“UM to lead Alzheimer’s study aimed at recruiting Blacks, Hispanics to help develop drugs,” via Daniel Chang of the Miami Herald — Much of the genetic information gathered in clinical studies comes from non-Hispanic white people of European descent, as genetic studies have historically excluded people of African and Hispanic ancestry, said Dr. Margaret Pericak-Vance, a geneticist and director of the John P. Hussman Institute for Human Genomics at the University of Miami’s Miller School of Medicine. Without a diverse pool of genetic data that includes people of African and Hispanic ancestry, researchers will have fewer targets for developing drugs that can treat, cure or prevent Alzheimer’s disease, one of the leading causes of death in South Florida and the United States.

— PENCIL IT IN —

Monday

Happy birthday, Rep. Jackie Toledo

Tuesday

10 a.m. AHCA hosts a rule development workshop on proposed changes to Rule

59A-36.012 about food service standards at assisted living facilities and proposed changes to Rule 59A-36.021 about extended congregate services.

Wednesday

Happy birthday, Sen. Darryl Rouson

3 p.m. The Medicaid Medical Care Advisory Committee meets. Meeting link here.

Email [email protected] for a copy of the agenda.

Thursday

Happy birthday, Sen. Gayle Harrell

2 p.m. AHCA hosts a rule development workshop on proposed changes to Rule 59A-36.015 about record keeping in assisted living facilities.

Friday

Happy birthday Sen. Victor Torres

Happy birthday Rep. Alex Andrade

8 a.m. The Board of Psychology meets. Call (888) 585- 9008; participant code: 564341766. Agenda here.

The Republican Party of Florida Sunshine Summit and Victory Dinner kicks off. Seminole Hard Rock Hotel and Casino in Hollywood.