Diagnosis for 12.19.22: 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.

With less than a month to go in the open enrollment period, more than 1.44 million Floridians have signed up for health insurance under the federal health care exchange, according to data released this month by the Centers for Medicare & Medicaid Services.

Florida continues to lead the nation in the number of residents who rely on the exchange implemented as part of the Affordable Care Act, also known as Obamacare. Texas is second in the nation, with slightly more than 1 million residents enrolled in an exchange.

CMS reported that so far in December, nearly 5.5 million Americans have signed up for 2023 coverage. This includes 4.9 million selections made through the federally run HealthCare.gov platform and about 600,000 through state-based marketplaces.

This year’s open enrollment period began Nov. 1 and runs until Jan. 15 for states that rely on the federally run Healthcare.gov platform.

In 2022, more than 2.7 million Floridians signed up for health care coverage through the health care exchange, according to data compiled for KFF. The enrollment totals have been rising over the past decade.

U.S. Census data released in September estimated that 12.1% of Floridians do not have health insurance coverage in the state. Florida has the fourth-highest uninsured rate behind Texas, Oklahoma and Georgia.

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— Buh bye —

After more than a decade at the helm of the Agency for Persons with Disabilities (APD), Director Barbara Palmer is resigning effective Dec. 30.

In a Dec. 2 letter, Palmer said that Gov. Ron DeSantis, who has been her boss for the last four years, asked for her resignation.

“Helping protect the health and safety of individuals with developmental disabilities has been my privilege and the pinnacle of my career,” Palmer wrote. “Since my start at APD in 2011, with the help of our dedicated and professional staff, we have worked to improve the lives of some of the most vulnerable citizens of Florida.”

Attached to the one-page resignation letter were another nine pages that include what Palmer described as her “accomplishments and highlights,” including shuttering Carlton Palms Educational Center, setting up the Medicaid iBudget waiver program, and taking 7,000 people off the waiting list for the iBudget Medicaid waiver program.

The iBudget waiver allows people with intellectual or developmental disabilities to obtain home and community-based services that, while not traditionally covered by the Medicaid program, will keep them from being institutionalized.

While Palmer, who earns $168,000 annually, lists it as a success, the iBudget program passed before she headed the agency. And the 7,000 individuals Palmer says she removed from the Medicaid iBudget waiting list includes projections.

Meanwhile, the iConnect program Palmer calls an accomplishment was supposed to be fully implemented by 2018 but hasn’t been. It also has been decried by Medicaid iBudget support coordinators, providers and clients.

“There’s been a whole host of problems with iConnect, and there’s a lot of people experiencing difficulties with iConnect from waiver support coordinators to providers to the consumers it supports. It’s been very difficult to implement, very difficult for providers to use and there’s been ongoing issues for several years,” Mark A. Swain, the CEO and President of ARC of Alachua County and Arc of Florida Board Chair, told Florida Politics. “I think the value of iConnect will be seen upon its completion. I don’t think the state has seen the value of iConnect yet.”

Swain does credit Palmer for “seeing the closure of Carlton Palms through,” but it occurred after a series of deaths published by media reports that took place under her watch.

“Carlton Palms was a real black eye for Florida,” he said. “It went on far too long, and it should have been shut down before it was. The state had no other choice but to finally close it.”

Palmer’s departure leaves the top position at the APD open. DeSantis’ office did not immediately comment on who would replace Palmer or when the new director will be announced.

Palmer is not the only agency head to resign in recent weeks.

Agency for Health Care Administration Secretary Simone Marstiller submitted her resignation letter to DeSantis on Nov. 9, after the Governor was re-elected. Dane Eagle, secretary of the Department of Economic Development, has also resigned. And Florida Insurance Commissioner David Altmaier tendered his resignation Thursday. Altmaier has not publicly disclosed where he will be working.

The agency head resignations come before a new six-year lobbying ban takes effect and prevents Florida’s top regulators and agency secretaries from lobbying the Florida Legislature, or the offices they once worked at, for six years. Florida law precludes former executives from lobbying the agencies they served and the executive office for two years. The ban doesn’t apply to lobbying the Florida Legislature.

Not all agency heads are resigning. Department of Children and Families Secretary Shevaun Harris is staying with DeSantis for his second term, and so is Department of Health Secretary and state Surgeon General Joseph Ladapo.

— Who’s running the OIR? —

Florida’s top health insurance regulator, John Reilly, is stepping down from his position as the OIR Deputy Commissioner of Life and Health and has taken a job at Oscar Health, sources close to the Commissioner said.

Reilly has headed the state insurance unit regulating licensed life and health care plans. The unit reviews all life and health policy rates and forms and also conducts examinations and investigations into business practices and alleged statutory violations. According to a state website, Reilly was hired in 2008 and earned about $137,000 annually.

Reilly is the third insurance regulator to leave the state department before a new six-year lobbying ban takes effect.

Susanne Murphy stepped down as the Deputy Commissioner of Property & Casualty earlier this month and took a job at Meenan PA; she oversaw the regulation of property and casualty insurance policies, which includes Florida’s beleaguered homeowners’ insurance market, and was Reilly’s counterpart.

Meanwhile, Reilly’s arrival at Oscar Health comes as the plan announced it was cutting off open enrollment in Florida on the federal health insurance exchange two days before the end of the open enrollment period.

In third-quarter filings with the SEC, the company said it had “proactively engaged CMS regarding options to manage (its) membership growth to a level at the end of the 2023 Open Enrollment Period that enables us to prudently manage (its) capital.”

— Another meeting —

Members of one of the state’s medical boards will hold another public meeting on proposed rules to ban physicians from offering gender-affirming care to minors.

The Department of Health is scheduling a Board of Medicine meeting after receiving two requests to do so, said department spokesperson Brad Dalton. Dalton told Florida Politics the DOH was working with board members on completing a meeting date.

The Board of Medicine agreed in November to alter the standard-of-care rules to ban doctors from performing gender-confirming surgeries on anyone under 18 and from supplying puberty blockers and hormones to anyone under 18, a position that Ladapo advocated.

It’s not clear whether the Board of Osteopathic Medicine will also hold a meeting on its proposed rule on gender-affirming care, also approved on Nov. 4.

Its proposed rule would allow osteopathic physicians to treat patients with puberty blockers and hormones if they agreed to take part in Institutional Review Board-approved, investigator-initiated clinical trials at one of Florida’s medical schools.

It is one of the first times, according to the medical board’s legal staff, that there could be different standard of care rules based on whether someone is a medical doctor or an osteopathic physician.

— Meet the new board —

Members of the Board of Osteopathic Medicine meet next week to elect a new board Chair and Vice Chair and to meet new members.

DeSantis has appointed three new members to the board since November: Tallahassee physician Gregory Williams, Jacksonville pediatric endocrinologist Monica Mortenson and Winter Park consumer advocate Chris Creegan.

Williams is a physician with Tallahassee Primary Care Associates. He is a Fellow of the American Academy of Family Physicians and is a clinical assistant professor for the Florida State University College of Medicine.

Mortensen is a pediatric endocrinologist with Nemours Children’s Health. She is a courtesy assistant professor at the University of Florida College of Medicine, department of pediatrics in Jacksonville.

Creegan is the owner and broker of Creegan Group. He was recognized in 2022 by RealTrends as one of the top Realtors based on the number of homes sold, ranking No. 31 out of all Realtors in the United States.

Drs. Sandra Schwemmer was initially appointed to the board by then-Gov. Rick Scott in 2015, and Michelle Mendez, who was re-appointed to the board by Scott in 2017, no longer serve on the board.

— RULES —

— AHCA proposes to amend Rule 59A-36.015 to update record-keeping requirements in assisted living facilities. More here.

— The Board of Acupuncture is proposing to amend Rule 64B1-7.0015 to mandate education about electromagnetic sensitivity safety standards. More here.

— The Board of Podiatric Medicine proposes the rule development to conduct a comprehensive review and to decide if there are any needed updates, changes, or corrections to the rule language. More here.

— The Board of Pharmacy proposes the rule amendment to update language on expiration dates of unclaimed prescriptions. More here.

— The Board of Chiropractic Medicine proposes amending Rules 64B2-17.006 to update requirements for the retention of chiropractic records. More here.

— The Board of Chiropractic Medicine proposes amending Rule 64B2-11.001 to revise applications. More here.

— ROSTER —

— Rep. Marie Woodson was named the ranking Democratic member of the House Health Care Appropriations Subcommittee, Rep. Kelly Skidmore was named the ranking member of the Health & Human Services Committee, Rep. Felicia Simone Robinson was named the ranking member of the House Children, Families & Seniors Subcommittee, and Rep. Robin Bartleman was named the ranking member of the Health Care Regulation Subcommittee.

— DeSantis announced the appointment of Diana Forst, Judy Frum, Jenee Peters, and Jennifer Wages and the reappointment of Jody Rain to the Board of Nursing. Forst is a registered nurse (RN) at Cleveland Clinic. She was previously appointed to the 19th Circuit Judicial Nominating Commission. Forst earned her associate degree in nursing from Marymount University and her bachelor’s degree in biology from Trinity College. Frum is the chief executive officer of Broward Health Imperial Point. She serves on the Board of Directors of the Pompano Beach Chamber of Commerce and is an Advisory Board Member for Sheridan Technical School. Frum earned her associate degree in respiratory therapy from West Virginia Northern Community College, her bachelor’s degree in nursing from Florida Atlantic University, and her master’s degree in business administration from Florida International University. Peters is the managing director at Naples Wealth Planning and the founder of Tampa Bay Body Sculpting. Previously, she was a partner with Platinum Wealth Partners and was the executive director of Investments for Oppenheimer & Co. Inc. Peters earned her bachelor’s degree in business administration from Baldwin-Wallace University. Wages is the health information management director of Encompass Health of Panama City. She is a current American Society for Health Care Risk Management member. Wages received her practical nursing certification from Haney Vocational School and earned her bachelor’s degree in health care administration from Southern New Hampshire University. Rain is the RN nurse supervisor at Manatee Memorial Hospital and the Clinical Solutions Director of PointClickCare. She is the former president of the Manasota Chapter of the Emergency Nurses Association. Rain earned her bachelor’s degree in nursing from the State College of Florida and her master’s degree in health care administration from Western Governors University.

— DeSantis also appointed Daniel Adler to the Lee Memorial Health System Board of Directors. Adler, of Fort Myers, is Millennium Physician Group’s legal compliance director. He was previously appointed as a Special Assistant General Counsel for the White House. Adler earned his bachelor’s degree from Rollins College, his master’s degree in law from George Washington University, and his law degree from Appalachian School of Law.

— LOBBYING —

— Melanie R. Brown, with Johnson & Blanton, has registered to lobby for AdventHealth

— Ashley Shew has registered to lobby for the American Association of Nurse Practitioners.

— Douglas S. Bell, James R. Daughton Jr., Leslie Y. Dughi, Allison Liby-Schoonover, Aimee Diaz Lyon, Andrew T. Palmer, Karl Nels Rasmussen, with Metz Husband & Daughton, have registered to lobby for Ipsen Biopharmaceuticals.

— Jonathan J. Rees has registered to lobby for Jazz Pharmaceuticals and its subsidiaries, including Greenwich Biosciences.

— Travis W. Blanton, Marnie L. George, and Jon E. Johnson, with Johnson and Blanton, have registered to lobby for Transition Life Center.

— ETC —

— AHCA has given tentative approval to three new hospice programs in Hernando County. Regency Hospice of Northwest Florida, Seasons Hospice & Palliative Care of Pasco County, and VITAS Healthcare Corporation of Florida were approved for projects. The tentative decisions can be appealed to the Division of Administrative Hearings.

— Optum, the businesses in the UnitedHealth Group, has awarded a $50,000 grant to the Florida Behavioral Health Association (FBHA) to support its members with post-Hurricane Ian recovery. The grant will help FBHA members in Southwest Florida rebuild and recover from Hurricane Ian’s impact while continuing to serve clients in the region. Six FBHA member providers employ more than 500 staff in cities across Lee, Charlotte, and Collier counties.

— Among persons who died with cancer, 2.0% in 2020 and 2.4% in 2021 had COVID-19 listed as the underlying cause of death, with higher percentages during COVID-19 peaks and among persons who were older, male, Hispanic or Latino, non-Hispanic American Indian or Alaska Native, non-Hispanic Black or African American, or living with leukemia, lymphoma, or myeloma. 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

— The waiting: The ban on abortions after 15 weeks of pregnancy passed by Florida lawmakers earlier this year could be further reduced to 12 weeks next year, one of the top legislative leaders said Thursday. But the Legislature might need to wait until the courts rule on the current law before they move forward with further restrictions.

— Lead or follow? DeSantis was asked if he would “take the lead” on the “heartbeat bill,” which would ban terminations of pregnancy if there were a detectable fetal heartbeat. “I’m willing to sign great life legislation. That’s what I’ve always said I would do,” DeSantis said, as House Speaker Paul Renner looked on.

— Jumping ship: Another high-ranking official at the state’s largest health care agency is leaving her post. Julie Madden, Agency for Health Care Administration Deputy Secretary of Operations, is retiring. Madden is one of three Deputy Secretaries at the health care agency. She oversees several large program areas, including financial services, human resources, general services, purchasing and contract administration, information technology (IT), and administration of the Florida Health Care Connections (FX) Program.

— Keeping COVID in the headlines: DeSantis wants the state Supreme Court to impanel a statewide grand jury to investigate crimes and wrongdoings the pharmaceutical industry may have committed against the state’s residents on the COVID-19 vaccine. DeSantis initially directed the vaccine to seniors, touting them as life savers.

— Will it get a hearing? Democratic Sen. Tina Polsky of Boca Raton filed a bill that would strip language out of state law prohibiting same-sex marriage. The 15-line bill (SB 80) would repeal laws that still are on the books, despite the 2015 U.S. Supreme Court ruling Obergefell v. Hodges that required all states to issue marriage licenses to same-sex couples and recognize same-sex marriages.

— FOR YOUR RADAR —

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

—“COVID-19 hospital admissions boom in Florida, but intensive care units aren’t so full” via Chris Persaud of Palm Beach Post — COVID-19 is hitting Florida’s hospitals harder this winter than last year. Still, these cases seem less severe, thanks in part to immunity. COVID-positive patient counts in medical facilities statewide are about 33% higher compared with a year ago, data released Friday by the U.S. Health and Human Services Department shows. But the number of people in intensive care units is about 36% less. Hospitals statewide that reported to the federal government counted 1,591 COVID-positive patients Friday, compared to 1,195 on Dec. 16, 2021.

—“Why it’s hard to get Medicaid expansion in front of Florida voters” via Rachana Pradhan and Daniel Chang of Kaiser Health News — In Florida and Wyoming, the two remaining states where voters have the option, excessive costs and other hurdles baked into the ballot process make it almost impossible to enact a measure, advocates say. “Each of those states, for different reasons, is particularly difficult to move a Medicaid expansion ballot measure through,” raising questions about whether it is “an effective strategy,” said Kelly Hall, executive director of the Fairness Project. The Washington, D.C.-based nonprofit has funded Medicaid ballot campaigns in multiple states and has pushed other progressive causes, including raising the minimum wage and guaranteeing paid sick leave for workers.

—“Experts express confusion, concern as Ladapo begins new COVID-19 study” via Caroline Catherman of Orlando Sentinel — Some medical professionals and researchers worry Ladapo may be doing harm by stoking fear about vaccines without sufficient evidence. “I have no issue with him investigating further; we need more data on COVID and correlates of COVID. I am worried about the messaging to our communities and perhaps causing concern when there, in fact, may be no issue,” Elena Cyrus, an epidemiologist from the University of Central Florida, said in an email Wednesday. Clinical trials and extensive observational studies on hundreds of millions of vaccine recipients suggest a slightly increased risk of myocarditis following COVID-19 vaccination — something vaccine companies, health care providers, and federal agencies advertise.

—“Oscar Health puts brakes on new ACA sign-ups in Florida” via Jeff Lagasse of Healthcare Finance — Health insurance company Oscar Health will temporarily stop accepting new members in the state of Florida beginning today, a move the company said was based on a strong Affordable Care Act Open Enrollment performance. Current Oscar members in the state seeking plan renewal for 2023 will not be affected. They can renew their ACA plan for 2023 throughout the rest of open enrollment through the exchange or their broker. Any new Oscar members in Florida enrolled for 2023 before Tuesday are also unaffected. Oscar said it is still “steadfast” in the Florida market and intends to continue to supply coverage throughout 2023 and beyond.

—“Florida health department building in Orange still closed after nearly $2 million in hurricane damage,” via Caroline Catherman of Orlando Sentinel — The Florida Department of Health in Orange County’s central office is about to reach month three of closure, with at least another month to go as repairs continue. The four-story Central Health Center building in downtown Orlando sustained nearly $2 million in damage during Hurricane Ian in late September after heavy rain wrecked the roof and flooded the building’s interior, said Reed Knowlton, financial adviser to Orange County.