Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Gov. Ron DeSantis is signaling he is poised to act against manufacturers of COVID-19 vaccines.
During a Republican holiday gathering at the Governor’s mansion last weekend the Governor told a group that “we are going to hold these manufacturers accountable for this mRNA, because they said there are no side effects, and we know there have been a lot.”
He then cited a Florida analysis released in October by State Surgeon General Joseph Ladapo about an increased risk of cardiac-related deaths among males 18-39 after taking a COVID-19 mRNA vaccine. That analysis has drawn sharp criticism from medical experts as flawed.
DeSantis added again “we’re going to do some stuff to bring accountability there.”
When asked about the Governor’s comments, a spokesperson suggested staying tuned; more details should be forthcoming in the next few weeks.
Social media amplified DeSantis’ remarks last weekend, which drew attention from conservative media outlets and may point to a new round of action designed to draw attention to his handling of the COVID-19 pandemic.
While Florida early on did shut down businesses and in-person classes, DeSantis pushed to reopen the state much earlier than most of the country, including opening schools. He also opposed vaccine mandates and pushed to pass a law that bans the requirement that people supply proof of vaccination known as “vaccine passports.”
DeSantis emphasized his COVID-19 record during his re-election campaign and he and other Republicans say it has led to people moving to Florida.
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— Here comes FSU Health —
It’s being called the most ambitious intellectual project Florida State University (FSU) has ever pursued. And FSU President Richard McCullough predicted FSU Health would “reshape patient care, education and research throughout Florida.”
FSU Health is the moniker the university is giving a new $125 million medical research center in Tallahassee as well as the overall goal for FSU College of Medicine, other health care professional programs and research to move beyond Tallahassee and into northwest Florida and the rest of the state.
“FSU Health will reshape patient care, education and research throughout Florida,” McCullough said. “The Florida Panhandle is booming and the possibilities — and needs — in our region have never been greater. We are at a very exciting time as we lay the foundation for this monumental project.”
Lawmakers agreed to supply $125 million in the fiscal year 2022-2023 budget to fund the five-story building. The building will be found on TMH’s campus.
FSU also is expanding its footprint in Panama City, where a branch location is located. FSU, TMH and St. Joe Company announced in spring 2021 plans to develop an 87-acre health care campus nestled close to Latitude Margaritaville Watersound, a master-planned 55-plus living community in Panama City. The campus will include an urgent care center, a 100-bed hospital and facilities for research and educational opportunities.
“We have a real opportunity to create meaningful change for Panhandle residents who currently drive several hours to Tallahassee, Gainesville or Mobile for their medical needs,” FSU Vice President for Research Stacey Patterson said. “The FSU Health initiative can create better care options while also creating jobs, educational opportunities and a major expansion of research and development in the region.”
— It’s the defense fees (duh) —
As business groups look to the upcoming Legislative Session to reinstate limits on what injured workers can pay their attorneys, a new state report shows it’s not the injured workers who are driving legal costs in the system.
The amount of money injured workers spent on plaintiffs’ attorneys during the state fiscal year 2021-2022 decreased by nearly 1.9% over the prior year, while insurance company defense fees increased by nearly 5.6% from 2020-2021, according to the report released by the Office of the Judges of Compensation Claims.
In all, $504,243,763 was paid in legal fees in a system that is supposed to be self-executing. That’s a 2% increase over $494,505,716 spent on plaintiffs’ attorneys and defense attorneys in the fiscal year 2020-21.
Slightly more than 53% of the overall attorneys’ fees paid between and June 30, 2022, were paid to defense attorneys.
Workers’ compensation is a no-fault system meant to protect workers and employers. It is supposed to provide workers who are injured on the job access to medical benefits they need to be made whole. In exchange for providing those benefits, employers generally cannot be sued in court for causing injuries. The system is generally set up to avoid lawsuits, but disputes about benefits often lead to legal fights. When they do arise, Florida relies on the OJCC to mediate and/or adjudicate the cases.
Workers’ compensation premiums have decreased in Florida for six consecutive years with Insurance Commissioner David Altmaier last month ordering an average 8.4% reduction in rates for new and renewed policies effective Jan. 1, 2023.
Florida Chamber of Commerce Vice President of Government Affairs Carolyn Johnson told Florida Politics at the time that the reductions were welcome news for Florida’s businesses. She added that she was hopeful rates could continue to decrease in the future and cost drivers that still are in the workers’ compensation system, “like uncapped attorney fees,” don’t interfere.
For more than a decade plaintiffs’ fees in Florida’s workers’ compensation system were capped at 20% of the first $5,000 in benefits secured, 15% of the next $5,000, 10% of the rest to be provided during the first decade and 5% of the benefits secured after those first 10 years. The law does not restrict what insurers can spend defending workers’ compensation cases.
The Florida Supreme in 2016 issued Castellanos v. Next Door Company, a 5-2 decision that resulted in the elimination of the strict fee caps on attorney’s fees injured workers accrue. Regulators later approved a 14.5% rate increase, largely based on that decision as well as another 2016 ruling, Westphal v. City of Saint Petersburg, in which a two-year ban on temporary total disability benefits was ruled unconstitutional.
The lengthy 300-page OJCC report provides insights into the entire workers’ compensation, not just attorneys’ fees. For example, judges presiding over compensation claims authorized worker benefits in excess of $1 billion in FY 21-22.
The report also shows the number of workers’ compensation cases in FY 21-22 was up from the previous year, but the overall number of petitions filed is still below the levels right before the COVID-19 pandemic.
There were nearly 31,000 cases filed — a nearly 3.8% increase from the previous year — and nearly 72,000 petitions overall, which was a 3% increase. (Sometimes an injured worker can file multiple petitions connected to a single incident.)
— Where’s the transparency, DCF? —
Forty Florida health care organizations and advocacy groups sent a letter to the DeSantis administration this week asking that it publish the plan it intends to follow when the federal COVID-19 public health emergency (PHE) expires.
The PHE has pumped billions of added federal Medicaid dollars into Florida. But the additional money comes with the requirement that states maintain enrollment of nearly all individuals enrolled in Medicaid. As a result of the continuous eligibility requirement, Florida’s Medicaid program has grown to more than 5.5 million people, 1.7 million of which have enrolled since the pandemic started in 2020.
When the continuous enrollment requirement expires, states will generally have up to 12 months to return to their pre-pandemic eligibility and operations for enrollment in the traditional Medicaid program and the federal children’s health insurance program (CHIP), which in Florida is called KidCare.
It will be the largest health care coverage transition event since the initial opening of the so-called Obamacare plans on the federal health insurance exchange.
To help ensure people don’t lose their health care coverage, the federal government has issued recommendations for states to follow, including updating enrollees’ basic contact information.
The 40 groups that signed onto the letter want the DeSantis administration to publish the health care transition plan and to take advantage of the 12-month transition period to help ensure enrollees “have seamless transitions to other forms of coverage if they no longer qualify for Medicaid.”
The letter also asks the administration to follow other states’ lead, like North Carolina, Utah and Oklahoma and publish their post-PHE Medicaid determination plans.
DCF said in a statement it had been working with AHCA on an “outreach campaign” that communicates the importance of providing updated contact information. DCF did not comment on whether it would publish its transition plan but said in a statement that children who no longer qualify for Medicaid in Florida are automatically referred to KidCare. Adults, she said, will be referred to a program called Medically Needy, made available to people who normally wouldn’t qualify for Medicaid benefits but have suffered a catastrophic illness.
DCF’s statement did not mention referring adults to the federal health insurance exchanges for Obamacare policies.
“To those groups creating unnecessary panic by insinuating that Florida is not prepared, we can assure you that the Department is prepared, there is a plan in place that is updated as CMS rules change, and we look forward to these group’s cooperation in pushing our messaging out to the millions of families enrolled in the Florida Medicaid program,” the agency stated.
— The bright spot —
Florida’s Medicaid rolls ballooned by more than 1.7 million people during the pandemic, 575,000 of which are children under the age of 19.
With a mandate that the state keep continuous eligibility throughout the PHE, the percentage of uninsured children in Florida (and nationwide) declined in 2021, according to a report by the Georgetown University Center for Children and Families (CCF).
Florida’s uninsured rate dropped from 7.6% to 7.3% in 2021, U.S. Census data examined by CCF researchers shows. Nationally, the percentage of uninsured children dropped from 5.7% to 5.4%.
Children in low-wage-working families with annual income between approximately $30,000 and $55,000 for a family of three saw the biggest reductions in their uninsured rates.
The findings reversed what had been a three-year trend where the percentage of uninsured children in the nation increased. The childhood uninsured rate dropped to its lowest, 4.6% in 2016, according to CCF researchers. It increased in 2017 and 2018 and in 2019 reached 5.7%.
Standard Census data was not available in 2020 so there was no 2020 report.
CCF Executive Director and Georgetown McCourt School of Public Policy Research Professor Joan Alker said the dip in uninsured children has been a bright spot in the pandemic.
Alker joined Florida Policy Institute CEO Sadaf Knight and Florida Health Justice Project FHJP Executive Director Alison Yager at a news conference touting the findings and asking that the DeSantis administration work with advocates on smoothly transitioning children from the Medicaid program to Florida’s KidCare program following the expiration of the PHE.
Florida’s children are considered some of the most at-risk children in the nation to lose coverage when the PHE expires.
“The state must build a plan alongside community partners that ensures that no eligible child, family, or parent goes without health care,” Knight said at the news conference.
Yager said health care access is a stabilizing force in people’s lives and has been a factor in the state’s recovery from the pandemic.
“The state needs to accelerate the pace of preparation for the unwind so that coverage loss is mitigated to the extent possible.”
— Two down one to go —
AHCA has awarded one Florida Health Care Connections (FX) contract and extended the period for another.
The contracts and updates on the transformation of the current Medicaid management information system, commonly referred to as FMMIS, to the new FX system will be discussed next week at a four-hour FX Steering Committee meeting.
Gainwell Technologies LLC was awarded a seven-year $154.5 million contract for Medicaid claims and encounters processing last month and edged out Conduent State Healthcare, LLC for the contract. AHCA announced the award at the end of October and announced it would delay a decision on the third and last FX ITN until next year.
The core module will decide fee-for-service claims for Medicaid reimbursement, process managed care encounter transactions and support all Medicaid financial activity.
According to AHCA, “the FX core module represents the most fundamental functionality required for Medicaid transition and involves the longest combined time frame for planning, procurement, and implementation.”
The announcements mean the state has awarded two of the three Medicaid IT contracts associated with the transformation of FMMIS from a singular IT system into a modular one.
The timeline to award the third FX contract, estimated to be worth $33 million over a seven-year period, has been pushed back to Jan. 31, 2023.
The provider services module will electronically capture, confirm, and process provider enrollment applications (both initial and renewal), including an automated screening and monitoring component to support state and federal requirements, according to state documents.
The state had already pushed the time frame back twice before agreeing in November to push the announcement deadline to Jan. 31, 2023.
The contracts are being awarded as the state moves forward with scrapping its current angular Medicaid Management Information System. In all the state has awarded two of the three FX ITNs, previously awarding Automated Health Systems (AHS) a $140 million contract. Documents show the contract could be for up to 10 years.
The unified operations center (UOC) is responsible for all interactions between the agency and stakeholders, a group that includes customers, providers, vendors, other state agencies and others. The UOC is responsible for the management and tracking of outbound communications and printing, fulfilling and mailing (including standard and electronic mail) information of any type as approved by the agency on a scheduled and ad hoc basis.
— RULES —
— AHCA proposes amending. Rule 59A-36.015 to update record-keeping requirements and delete obsolete language. More here.
— The Board of Hearing Aid Specialists proposes amending Rule 64B6-5.001 to clarify continuing education necessary for renewal. More here.
— The Board of Hearing Aid Specialists proposes amending Rule 64B6-6.001 to update 30-day cancellation refunds. More here.
— The Board of Speech-Language Pathology and Audiology proposes amending Rule 64B20-8.009 to change the method of calculation for hearing aid refunds and cancellation fees. More here.
— The Board of Chiropractic Medicine proposes amending Rule 64B2-18.001 to update definitions and timelines. More here.
— ROSTER —
— Dennis Hollingsworth, chief of clinic management and informatics at DOH; Helen Sairany, Florida Pharmacy Association executive vice president and CEO; and AHCA Bureau of Medicaid Quality Bureau Chief Melissa Vergeson have been tapped to serve on the State Consumer Health Policy and Advisory Council.
— Susanne Murphy has joined the Meena PA law firm in Tallahassee. The former state insurance regulator will be an insurance regulatory consultant.
— Longtime volunteer Ken Thomas has been named the AARP state president.
— ETC —
— AmeriHealth Caritas Florida has earned the Multicultural Health Care Distinction from the National Committee for Quality Assurance. The Medicaid managed care plan, which serves seven Florida counties, was recognized for its excellence in providing services to meet the diverse cultural and linguistic needs of health plan members, and its work to help address health disparities.
— U.S. Rep. Kathy Castor has introduced the Increasing Access to Lung Cancer Screening Act (HR 9336) with New York Democrat Brian Higgins. Moffitt Cancer Center officials say screenings could save many lives and note lung cancer accounts for 25% of all cancer deaths each year.
— University of Florida Health became one of the first large academic health centers in the Southeast to begin using a robot-assisted system in total knee replacement surgeries this year. The system ends the need for a CT scan while improving precision and patient outcomes.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— She’s back: DeSantis’ administration in his second term continues to take shape, with the Governor announcing Michelle Branham will return as the Secretary of the Department of Elder Affairs (DOEA).
— Buh bye: Signaling that health care may be less of a priority in the House for the next two years, House Speaker Paul Renner has eliminated one of the chamber’s health care panels. Since 2012, the House has had a Health and Human Services Committee and three subcommittees under its auspices. But under Renner’s two-year term, there will be just two health care subcommittees: Children, Families and Seniors, and Health Care Regulation.
— Run the world: Senate President Kathleen Passidomo has put women in charge of health care policy and spending in the Senate. Passidomo announced Sen. Gayle Harrell will chair the Senate Appropriations Committee on Health and Human Services and Sen. Colleen Burton will chair the Senate Committee on Health Policy. Moreover, to ensure there is continuity between health spending and health policy, Passidomo appointed Harrell to the substantive policy committee, and Burton will serve on the health care spending panel. Indeed, 10 of the members of the Senate Health Policy Committee also serve on the Health Care Appropriations subcommittee.
— What gives? A new report looking at crime in Florida shows an 8.3% overall drop in 2021 compared to the previous year, with all categories of violent and property crime showing a decrease except for one: rape. A recently released analysis from the Florida Department of Law Enforcement (FDLE) shows there were 38,534 fewer “index” crimes reported for the calendar year 2021 than in 2022.
— From frustration to inspiration: Ever get tired of filling out the same mundane medical form asking about allergies, family history and current medications every time you go to the doctor? Tallahassee residents fed up with the paperwork may have the opportunity to help pilot a new app that allows patients to electronically share information with their providers about the medications they take, as well as their family history and their insurance.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
—“UCF epidemiologist worries the state is ripe for a ‘triple-demic’ as case counts rise” via WMFE’s Joe Mario Pedersen — Elena Cyrus, a University of Central Florida epidemiologist, said Florida’s sprawling demographic of children and seniors puts it at risk of seeing dangerous increases of all three viruses. “What do we have in Florida? We have Disney and a bunch of schools, and then we have a huge retiree population as well. So just by age alone, our demographic profile is set up for a certain level of vulnerability to have those three existing (diseases) occurring at the same time,” Cyrus said. Compounding the problem is vaccine numbers for both flu and COVID-19, which are not at an ideal level ahead of peak flu months in January and February.
—“Nine arrested in $37 million health care scheme in Miami. Is your clinic on the list?” via Michelle Marchante and Grethel Aguila of the Miami Herald — The group is accused of offering and paying kickbacks and bribes to beneficiaries of health care plans managed by Blue Cross Blue Shield, including to employees of JetBlue Airways, AT&T Inc. and TJX Companies Inc., according to court records. In return, the beneficiaries would enroll as patients at the clinics, which would submit fraudulent claims to Blue Cross for services that were never provided. Most of the clinics involved are in Miami-Dade County, and several have shared addresses in Doral and the Fountainbleu area, the indictment shows. Two of the other clinics are in Davie and Tampa.
—“Florida’s Surgeon General repeats opposition to COVID-19 vaccines” via Cindy Krischer Goodman of South Florida Sun-Sentinel —As federal health officials embark on a campaign this week to get more Americans boosted for COVID-19, Florida Surgeon General Ladapo is digging in on social media on an earlier claim that the mRNA vaccines are unsafe and linked to deaths from myocarditis. “mRNA COVID-19 vaccines are far less safe than any vaccines widely used,” the top health official in the state tweeted Dec. 2. “When does sanity return to science? Why do scientists breathlessly defend this technology?” Hundreds of anti-vaccine enthusiasts commented in support.
— “Project Opioid sends double-strength naloxone to downtown Orlando amid rising overdoses” via Caroline Catherman of the Orlando Sentinel — As powerful synthetic opioids like fentanyl continue to drive overdose deaths in Central Florida, traditional overdose-reversal methods aren’t working anymore. Naloxone, sold under the brand name Narcan, has been used for years to temporarily reduce the effects of opioid overdoses, restoring breathing and consciousness to an unconscious person within minutes. It can be injected or used as a nasal spray. However, synthetic opioids are so powerful that a single naloxone dose sometimes isn’t enough, the Centers for Disease Control and Prevention reports.
—“What happened to monkeypox in Florida?” via Sam Ogozalek of the Tampa Bay Times — New mpox cases have been dropping for months in Florida, mirroring a national trend. As of Wednesday, the state was averaging only two infections per day. Hillsborough, Pinellas and Pasco counties haven’t reported a case in over a week. By contrast, Florida saw 24 infections per day in mid-September, with local counties accounting for nearly a quarter of those cases, on average. The U.S. surge peaked in August, according to federal health officials. As of Wednesday, the nation was averaging just six infections per day. That’s down from 462 in early August.
— PENCIL IT IN —
Saturday
Happy birthday to Rep. Alex Rizzo.
Tuesday
Happy birthday to Agricultural Commissioner Nikki Fried.
2 p.m. AHCA hosts a meeting on proposed changes to Ruler 59B-9 about patient data collection and ambulatory surgery, and emergency department data reporting standards. Place: AHCA Building 3, Conference Room B, 2727 Mahan Dr., Tallahassee.
2 p.m. AHCA hosts a meeting on proposed changes to Rule 59E-7.012-59E-7.028 about inpatient data collection. Place: AHCA Building 3, Conference Room B, 2727 Mahan Dr., Tallahassee.
Wednesday
Happy birthday to Rep. David Borrero.
8 a.m. The Board of Respiratory Therapy meets. Call (888) 585-9008; participant code: 564341766.
10 a.m. AHCA hosts an FX Executive Steering Committee meeting. Place: AHCA Conference Rooms A, B, and C Building 3, 2727 Mahan Dr., Tallahassee. A copy of the agenda will be posted on the FX website.
10 a.m. The Rare Disease Advisory Council State Agencies Subcommittee meets. Microsoft Teams meeting link here.
Noon The Rare Disease Advisory Council meets. Microsoft Teams meeting link here.
Thursday
8:30 a.m. The Florida Board of Pharmacy meets. Agenda here. Place: Rosen Plaza Hotel, 9700 International Dr., Orlando.
10 a.m. The State Consumer Health Information and Policy Advisory Council meets. Webinar link here; Webinar ID# 564579435. Agenda here.
