Diagnosis for 8.29.22: 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 has led the nation in the number of people enrolled in the federal health care exchange through the arduous work of Florida Covering Kids & Families at the University of South Florida (USF) College of Public Health.

Headed by Jodi Ray, Florida Covering Kids & Families has partnered with organizations from across the state to provide navigator services and collectively operates under the Covering Florida moniker.

For years it has been the only navigator program in the state to receive money from the federal government. And Friday, the Biden administration announced it would earmark $12,908,382 to USF and Florida Covering Kids & Families for navigator services across the state.

But the Biden administration also awarded $2,624,933 to the Urban League of Broward County (ULBC). According to the federal government website, the ULBC will provide navigator services beyond South Florida because it will partner with the Tallahassee Urban League, the Pinellas County Urban League, and the Urban League of Palm Beach County.

Through those partnerships the Urban League of Broward County will be able to supply navigation services to people living in Tallahassee, St. Petersburg, Clearwater, Palm Harbor, Tarpon Springs, Delray Beach, Lake Worth, Jupiter, and other cities in the three counties outside of Broward.

The money is to cover the costs of navigation services between Aug. 27, 2022, and Aug. 26, 2023.

In all, the Biden administration last week awarded $98.9 million in navigator grant awards to 59 organizations in 30 states that rely on the federal health insurance marketplace for access to subsidized health insurance policies, commonly referred to as Obamacare plans.

Open enrollment for the 2023 plan year begins Nov. 1, 2022.

I welcome your feedback, questions, and especially your tips. You can email me at [email protected] or call me at 850-251-2317.

— Broward Health saga —

A Broward Health Commissioner is seeking guidance from the state’s Ethics Commission amid the fallout of the death of his father-in-law.

Ray Berry, the Health Business Solutions CEO first appointed to the public board that oversees North Broward County’s five-hospital system by then-Gov. Rick Scott, asked for an advisory opinion in late June after conflict-of-interest accusations from a company that claims Berry’s firsthand experiences could cause it to lose a lucrative contract.

In a letter to the Commission, Berry explained that his father-in-law suffered from multiple myeloma and that he was initially treated at a hospital run by Memorial Healthcare System, which is the public health system for South Broward County but was transferred to a Broward Health-operated facility.

Berry contends that his father-in-law died in 2019 in part of an inability of the two public hospital systems to exchange electronic health care records.

Berry said he made a promise not to sue the district over his father-in-law’s death if “proper procedures were implemented” and that “something like this never happens again” although attorneys for Broward Health acknowledge nothing was ever put in writing.

“I was distraught after my father-in-law’s death, both because a wonderful man was lost, but also because in my opinion, the district, where I serve as Commissioner, was partly responsible,” Berry wrote.

After Berry’s father-in-law died, Broward Health began looking at its electronic health record databases and whether it should replace its current vendor, Cerner, and possibly turn to the database provider used by the Memorial Healthcare System. It’s a process that is apparently still underway.

But attorneys for Cerner have raised questions about Berry’s role and whether his involvement has “tainted” the process and cited many times that Berry raised questions about Cerner.

In mid-May, an attorney with the Kutak Rock law firm sent a lengthy letter to Broward Health’s general counsel that contended Berry had used his public position on the board “to secure a special privilege and benefit for himself and his family.”

It said Berry was using his “personal situation” to “influence the situation” of the Broward Health board.

“Commissioner Berry’s unwillingness to recuse himself, and the failure of the board to demand his recusal, has created a serious litigation threat and any decision made at this point would likely be set aside by a court,” says the letter signed by attorney Diane Carter.

The staff for Florida Commission on Ethics, however, reviewed the situation and said there is no conflict on the two main questions asked by Berry, noting that he has no financial or contractual relationship with any of the electronic health database vendors.

The Commission staff did say it could not render an opinion on some of Berry’s other questions, including whether it’s a misuse of his position to speak out because it requires more information to determine someone’s intent.

“In addition, we do not typically provide guidance in response to entirely hypothetical inquiries where the facts giving rise to the potential ethical issue are not provided with particularity to the inquiry,” says the staff.

The entire complicated saga will be hashed out in front of the Commission itself at its Sept. 9 meeting. Commissioners could vote to issue the recommended advisory opinion or reach another conclusion.

— MMJ caps are here —

The Office of Medical Marijuana Use issued an emergency rule that, for the first time, places caps on the daily dosage amount of tetrahydrocannabinol included in edibles, vaporization pens, creams, suppositories, and pills that can be ordered and bought by qualified patients every 70 days.

Posted on its website Friday and published in the Florida Administrative Weekly Monday, the emergency rule caps at 24,500 milligrams the amount of THC a patient can be prescribed for edibles, vaporization pens, creams, suppositories, and pills. The emergency rule also reiterates the statutory limit of 2.5 ounces of smokable medical marijuana for qualified patients every 70 days.

Some lobbyists say implementing the 24,500-milligram dosage limits could prove problematic because the aggregate limits take effect when patients renew their licenses or when their physicians amend their pre-existing orders.

But the 70-day look-back period, which affects all certified patients, kicks in at once. That means, sources say, there will be different rules for different patients until the 745,259 certified patients have their licenses renewed.

The emergency rule allows qualified physicians who order medical marijuana for their patients, whether smokable or one of the other routes of administration, the ability to request an exception and includes the request for exception form.

Medical marijuana lobbyists say the request for an exception is a possible upside to the emergency rule because while the 2017 law authorized exceptions to the 2.5-ounce cap on smokable marijuana, there hasn’t been a process for physicians to follow until now.

The caps come as the state’s medical marijuana market continues to grow. As of Aug. 25, there were 745,259 people registered in the state to use medical marijuana in Florida and 22 licensed “medical marijuana treatment centers.”

The MMTCs are the only entities authorized to cultivate, process, and dispense low-THC cannabis and medical marijuana. Each MMTC is required to have a medical director.

Gov. Ron DeSantis denied to the press last week having direct involvement in conversations about the caps.

The move to place caps on the amount of THC comes as the state prepares to approve new MMTCs. Unsolicited, however, DeSantis offered his opinion that the state should increase the costs of the MMTCs licenses.

“We should charge these people an arm and a leg. I mean everybody wants these licenses. Why wouldn’t we take the opportunity to make money for the state based on those,” the governor said.

The governor said that would require a statutory change, though.

Meanwhile, this is the second emergency rule the OMMU has issued in the last 30 days. The office issued an emergency rule saying that medical marijuana treatment centers can only maintain one department-approved website and that centers cannot offer website purchasing services without first obtaining approval from the state.

The emergency rule defines website buying as the “purchasing of or making reservations or pre-reservations for the purchasing of usable product or marijuana delivery devices” through a medical marijuana treatment center.

— Social determinants of health and RFI —

To help address the social determinants of the health care needs of state residents the Agency for Health Care Administration (AHCA) wants to contract with one or more vendors to set up, operate and maintain a closed-loop referral system.

To that end, the agency published a “Request for Information” late last week seeking input from vendors or community-based organizations that have successfully implemented a cloud-based platform that is person-centered and built to be as seamless as possible for health care providers and the public.

According to the RFI, the system must, with the person’s consent: improve coordination between community-based and health care organizations; improve standardized data capture, data sharing, and data use for screenings, assessments, diagnosis, and interventions; and support Florida’s health information technology goals of improving public and population health through the efficient collection of information.

The RFI does not mention when the agency intends to obtain the services. But vendors or community-based organizations that have questions about the RFI can send them in writing to the agency by 2 p.m. on Sept. 2.

AHCA will answer the questions submitted by the deadline no later than 2 p.m. Sept. 12.

Social determinants of health are the circumstances in which people are born, grow up, live, work, and age and the conditions or factors that affect the quality of health care that they receive and the outcomes they experience.

“The impact of social determinants of health, including food insecurity, housing instability, economic instability, and interpersonal violence, on a person’s health and well-being, as well as on health care utilization and cost, is well-established. Currently, 90% of health care spending in the United States is on medical care in a hospital or doctor’s office. But research shows that up to 70% of a person’s overall health is driven by these other social and environmental factors and the behavior influenced by them,” the RFI notes. “Investing into these factors can improve health and result in a significant return on investment and health care cost savings.”

— Which projects will get the love —

There are only a few days left before Florida legislators are supposed to reveal how they will divide up the new $80 million “local support grants” program authorized in the budget.

The current state budget requires the Legislative Budget Commission to approve requests for the money no later than Sept. 15 — the same deadline that the joint House-Senate panel must annually approve a long-range three-year financial outlook.

The Legislature usually posts the agenda and all supporting materials for the Commission meeting no later than a week in advance. The House and Senate have yet to post an official notice for the next Commission meeting so the date — and the deadline to release the agenda — are still in flux but the clock is ticking.

Lawmakers submitted 971 spending requests totaling nearly $844 million by the submission deadline. An earlier Florida Politics analysis of the requests found that there were 70 health-care-related requests worth nearly $39.9 million.

This is the first time that legislators have ever pushed ahead with a program where they are the ones who will distribute the money. Some of the projects that have requested funding include items that DeSantis vetoed earlier this year, raising legal questions about whether the Legislature has the authority to sidestep that veto through this new program.

Additionally, the Senate has let the House take the lead in pushing ahead with the grants, including having that chamber maintain the website to post applications and keep track of requests. But LBC items require approval from both House and Senate members to move ahead so it will require buy-in from both chambers for the local support grants program to continue.

— RULES —

The Board of Optometry is developing Rule 64B11-4.001 that didactic training may be in person or from interactive, real-time courses. More here.

The Department of Financial Services proposes amending Rule 69L-7.100 to update the maximum reimbursement allowances for various medical services. More here.

The Department of Financial Services proposes amending Rule 69L-7.501 reimbursement manual for hospitals. More here.

The Department of Veterans Affairs proposes amending Rules 55-11.003, 55-11.005, 55-11.006, 55-11.009 and 55-11.012 about the admission and residency to the Department’s Veterans’ Domiciliary Home of Florida, in Lake City. More here.

Here’s a list of health-care-related rules that will take effect in early September

64B8-8.001 Updates disciplinary rules to specifically add PIP fraud to the list of punishments. It takes effect on Sept. 12, 2022.

64B8-9.0091 Updates the physician office surgery registration; inspection or accreditation rules. It takes effect on Sept. 11, 2022.

64B5-14.002 Updates the rules on the administration of anesthesia about anesthesia in dental offices. It takes effect on Sept. 12, 2022.

64B5-14.003 Updates the rules on the administration of nitrous oxide inhalation analgesia in dental offices. It takes effect on Sept. 12, 2022.

64B5-16.006 Updates the rules on remedial tasks that can be delegated to a dental hygienist. It takes effect on Sept. 12, 2022.

— ETC —

— The Florida Department of Transportation is issuing an “Airport Site Approval Order,” for Apopka Emergency Services Facility, a private airport, in Orange County that will be owned and operated by the City of Apopka.

— Calhoun Liberty Hospital, Inc. is soliciting formal, competitive, sealed bids from contractors for the construction of a new 2-story 25-Bed critical access hospital at a new site in Blountstown. Added work for the project includes the construction of the service building/central utility plan, helipad, and site work. Construction consists of approximately 76,000 square feet. Calhoun Liberty Hospital Association, Inc. will receive sealed bids until 2 p.m. (Central time) Tuesday, Oct. 11, 2022, at the Calhoun County Airport-F95 located at 16701 NW Agri Park Road, Altha, Florida 32421. Bids will be opened publicly and read aloud at 2:01 p.m. Oct. 11.

A mandatory pre-bid meeting for general contractors will be Tuesday, Sept. 6, 2022, at 2 p.m. (Central time) at the Calhoun County Airport-F95 located at 16701 NW Agri Park Road, Altha, Florida 32421. For more information, contact Emily Winston at [email protected]

— AHCA accepted two letters of intent for the Sept. 28 hospice CON cycle from vendors that want to build hospice programs in Hernando County: Affinity Care of Hernando County LLC and Seasons Hospice & Palliative Care of Pasco County, LLC, dba AccentCare Hospice & Palliative Care of Pasco County.

— LOBBYING —

— Ronald Book and Kelly Mallette have registered to lobby for the Florida Pharmacy Association

— Michael Kesti registered to lobby for the National Bio+Green Sciences LLC

— Lisa Rawlins withdrew from lobbying for Centralis Health

— ROSTER —

Chuck Hall, HCA Healthcare Inc.’s National Group president, will retire at the end of the year after nearly 36 years with the organization. Currently, Hall handles HCA Healthcare’s operations at 96 hospitals across 13 states. Before assuming that role Hall was president of several HCA Healthcare divisions, including North Florida, East Florida, South Florida and Southwest Florida

Rogerio C. Lilenbaum, M.D., FACP, FASCO has been named Senior Vice President and Chief Physician Executive at Junior Medical Center. Dr. Lilenbaum previously held executive roles at Yale Cancer Center, Yale New Haven Health, MD Anderson Cancer Center at Banner Health, and Cleveland Clinic.

DeSantis reappointed David Hidalgo, a certified registered nurse anesthetist for Envision Services and former Florida Association of Nurse Anesthesiology board member, to the Lake-Sumter State College District.

— ICYMI —

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

— After touching two patients’ breasts state moves to revoke license, levy $10K fine: A state administrative judge is recommending a Live Oak physician be fined $10,000 and have his license revoked after finding that he inappropriately touched two of his female patients’ breasts.

— Workers’ comp rates could be reduced by 8.4% in 2023: Here’s a bit of good news for Florida business owners. The National Council on Compensation Insurance (NCCI) this week submitted a filing to the state insurance department that recommends an 8.4% reduction on new and renewed policies effective Jan. 1, 2023.

— Enrollment in Medicaid is expected to grow but economists predict a $1.25 billion surplus: Florida’s Medicaid program continues to grow as more residents are expected to turn to the safety net program for health coverage. But despite a projected rise in enrollment, state economists say the growth will not cause a major budget disruption for state legislators this year.

— Ten named to the Florida Veterans’ Hall of Fame: The Florida Veterans’ Hall of Fame Class of 2022 inductees has been set. Florida Department of Veterans Affairs Executive Director James S. Hartsell told the Cabinet Tuesday 40 applications were submitted to the Florida Veterans’ Hall of Fame Council for consideration this year. The Council vetted the applications and sent to Hartsell the names of 10 veterans selected for induction into the hall this year.

— UCF researchers secure $4.5 million in funding to prepare for next health crisis: The University of Central Florida (UCF) is launching a $4.5 million research project that educators believe will help the next time a pandemic strikes. Dubbed the Infectious Disease and Travel Health Initiative, the goal of the program is to create an advance warning system for small to medium-sized businesses in tourist areas. The research is a collaboration of faculty members from UCF’s medical school and hospitality and engineering colleges.

— FOR YOUR RADAR —

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

“Florida’s transgender debate affecting treatment, surgeries” via Christopher O’Donnell of the Tampa Bay Times — While Florida considers banning hormone therapy and surgeries for transgender youth, the current political debate about treatment for gender dysphoria is already having a chilling effect on those seeking care. A surgery scheduled for a St. Petersburg transgender boy at Tampa General Hospital was canceled in June after both the hospital and the unaffiliated surgeon expressed concerns about performing the procedure over fears of future sanctions, according to the boy’s mother. More patients are traveling out of state to get treatment, according to some surgeons.

“Judge clears way for trial between UM, med school exec over firing. He is seeking millions” via Jay Weaver of the Miami Herald — Almost a decade ago, University of Miami President Donna Shalala fired a top executive at UM’s medical school, saying in a recent deposition that “his leadership was destructive to UHealth,” he “mishandled” layoffs during difficult financial times and he “destroyed morale” among the faculty. Jonathan “Jack” Lord, the former medical school’s chief operating and compliance officer, claims in a lawsuit against the university that Shalala retaliated against him after he repeatedly informed her of his efforts to probe $10 million in excessive Medicare billing by an organ testing lab for UM’s transplant program at Jackson Memorial Hospital.

“Are Florida’s public universities prepared for monkeypox?” via Cindy Krischer Goodman and Caroline Catherman of the South Florida Sun-Sentinel — Florida college students are back on campus just as monkeypox is spreading quickly in the state, including among young adults. But while universities are posting information and offering flyers about the disease, few are prepared for a campus outbreak. They have yet to announce how they plan to isolate students with the virus and help them keep up with classes, and few have acquired the Jynneos vaccine being used for people at elevated risk of monkeypox.

“Florida Blue, BayCare spar over health care coverage” via Christopher O’Donnell of the Tampa Bay Times — Tens of thousands of Tampa Bay residents may have to find new doctors by October as two of the region’s major health care players are publicly sparring over a new insurance contract. BayCare Health System this week sent 215,000 letters to patients insured through Florida Blue, warning that BayCare’s hospitals, doctors and lab services would be out of the insurer’s network by Oct. 1 if the two cannot agree on new health care rates.

“Planned Parenthood warns of ‘fake abortion clinics’ popping up in Gainesville” via Javon L. Harris of the Gainesville Sun — Fake abortion clinics appear to be popping up in an effort to trick women seeking assistance into facilities before trying to indoctrinate them with religious, pro-life propaganda. Pro-choice advocates say it’s a growing issue that has now affected Gainesville. Planned Parenthood says Crisis Pregnancy Centers (CPCs) in Gainesville are touting themselves as abortion clinics, luring unsuspecting women into their waiting rooms only to spread disinformation.

— PENCIL IT IN —

Tuesday

Happy birthday Rep. Lauren Melo.

Thursday

Happy birthday, Rep. Emily Slosberg.

Friday

Happy birthday, Rep. Spencer Roach.

Sunday

Happy birthday Rep. Evan Jenne.