Diagnosis for 2.22.23: 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.

— Say my name —

Florida’s health care delivery system is composed of a wide range of health care providers — from physicians to CNAs — with dozens of other providers in between. Patients, some argue, can be confused by who treats them.

SB 230 aims to bring some clarity by creating a new statute laying out the titles and abbreviations that health care providers may call themselves, use in advertising and use in a clinical setting. Sponsored by Sen. Gayle Harrell, the bill is supported by Senate President Kathleen Passidomo and is being fast-tracked in the Senate where it has been referred to the Health Care Policy and Rules committees. It cleared the Health Policy Committee by a 10-1 vote this week after Harrell offered a lengthy amendment that rewrote the original bill.

The bill requires health care practitioners to include their profession and the practitioner’s educational degree in all advertisements. The bill also requires health care practitioners to wear name tags that identify who they are and their profession, a move that the medical doctor (M.D.) and doctors of osteopathy (DO) opposed.

To get the MDs’ and DO’ support, Harrell amended the measure Monday to exempt them from having to wear the name tags. The exemption applies only when the MDs and DO are practicing in their offices. Additionally, the physicians would have to display copies of their licenses in “a conspicuous area of the practice so that it is easily visible to patients.” Health care providers that violate the law would be referred to their respective licensing boards for discipline.

Jacksonville health care attorney and Tallahassee lobbyist Chris Nuland told members of the Senate Health Policy Committee that the bill wasn’t a “scope of practice” debate. Scope of practice is a term used to describe the level of service and care providers are authorized to render in their practice. Attempts to expand a provider’s “scope of practice” often result in legislative battles.

“What this is, it’s a patient empowerment bill that allows them to understand who, in fact, is treating them,” said Nuland, who represents the Florida Society of Plastic Surgeons and the Florida Dermatology Association.

But not all provider groups are on board with the proposal, and neither were the members of the Senate Health Policy Committee. The Florida Nurses Association opposes the bill. “Hopefully this bill will not go all the way,” said lobbyist Jack Corey who represents the FNA.

Jack Hebert, government affairs director for the Florida Chiropractic Association said his association was 90% on board with the proposal but had some concerns still, including enforcement of the provisions.

Sen. Tracie Davis meanwhile said the bill has always “perplexed her” and voted against the measure.

“I am that person who is hearing that you are working with all the stakeholders so the only thing I want to do is to make sure we come back to this,” explaining why she was voting against the bill.

The counterpart to SB 230 is HB 583, which has been referred to the House Healthcare Regulation Subcommittee.

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

— Changes for state group insurance? —

The operation of Florida’s health insurance program for state employees could once again be a subject of debate — and possible change — during the upcoming Legislative Session.

The House’s main budget committee was given a presentation this week on the status of the nearly $3 billion program that provides health coverage to nearly 170,000 state workers, university employees and their respective families.

Even though overall enrollment has dipped slightly, the main trust fund that pays for the State Group Insurance Program is projected to slide into the red sometime during the 2023-24 budget year.

Katie Parrish, deputy secretary of Workforce Operations for the Department of Management Services, told members of the House Appropriations Committee that costs associated with health care benefits continue to rise. The state has also kept the premiums paid by state employees relatively unchanged for nearly two decades.

The department did contract for a cost containment study that it received in January that Parrish said focused on making changes to the plan design, costs for retirees and coordination of care that could lower costs. She said, however, that DMS was still reviewing the study to determine what recommendations it would eventually recommend to legislators.

One interesting side note: Rep. Ralph Massullo, a Lecanto Republican, questioned Parrish on why Moffitt Cancer Center was not part of the network of providers for employees enrolled in the main health maintenance organization (HMO) used by the state.

Massullo, a physician, said that state workers should have access to care at Moffitt since it receives money from the state. Parrish explained that the network is something put together by third-party administrators who manage the health care plan.

— Where’s the ITN? —

All eyes are on the state Agency for Health Care Administration (AHCA) these days and the Medicaid Invitation to Negotiate (ITN) is the reason.

The ITN could have been released as early as Feb. 20, which is 90 days after the state published the Medicaid Data Book. But two days later the ITN still hasn’t been published.

Managed care lobbyists speculated that AHCA would publish the ITN before the start of the 2023 Legislative Session or March 7.

Florida’s existing managed care contracts expire Dec. 31, 2024, which means AHCA wants to start the process of soliciting new contracts. The multiyear contracts are worth tens of billions to the Medicaid managed care companies that submit winning bids. Plans that aren’t chosen to participate in the program are locked out for six years unless they buy or merge with another health plan.

To help prepare for the procurement, the state last summer issued a five-page request for information asking those with experience in the Medicaid managed health care and Medicaid managed long-term care industries to provide the state with innovative ideas and best practices to improve Medicaid for patients who receive care and providers who render services.

— Limited lawsuit protections? —

This Legislature seems poised to amend the rules regarding how lawsuits are litigated in Florida and how attorneys get paid.

It’s strange that among all the chatter about the litigation changes the Legislature doesn’t appear to be willing to continue to shield health care providers, nursing homes, hospitals and doctors from lawsuits related to the pandemic.

The protections for health care providers were initially passed during the 2021 Session along with protections for general businesses. Unlike the general business protections, which have no expiration, the Legislature only extended the protections for health care providers for one year.

They are scheduled to end June 1, 2023, and it looks as if they will expire.

The Florida Health Care Association (FHCA) this week released its legislative agenda for the 2023 Session and an extension of the COVID protections was not included. FHCA CEO Emmett Reed said as the Legislature considers lawsuit protections the association is “working to educate the Legislature about the importance of bringing equity to the long-term care sector and the impact that the ‘sue-to-settle’ climate has on operations, as lawsuits divert resources necessary for investing in quality and damage staff morale.”

Associated Industries of Florida (AIF) also released its 2023 agenda this week. The agenda includes a lengthy list of “civil justice reforms,” many of which are contained in HB 837 filed by Rep. Tommy Gregory.

AIF notes that it supports what it calls liability protection “parity.”

“Those who provide the most critical services — from skilled nursing to affordable housing — should not be penalized for taking on the toughest tasks in our state. To this end, any liability protections should extend across the board to all industries,” the organization said. “For example, much like necessary protections exist for hospitals and physicians, they should exist for other providers performing similar services, such as assisted living facilities and nursing homes. A patchwork civil justice system results in exploitative litigation conduct, driving costs for the end users of the good or service.”

AIF does not mention the legal protections by name, but hospitals and physicians cannot be sued for wrongful death unless the deceased patient has minor children. Adult survivors cannot sue the providers for wrongful death.

The House Civil Justice Subcommittee takes up HB 837 when it meets at 8 a.m. Friday.

— Epidemic approaching? —

House Health & Human Services Committee Chair Rep. Randy Fine is jumping into the debate over providing minors access to gender-affirming and gender-confirming care.

Chloe Cole, an 18-year-old who has “detransitioned,” told members of the panel Tuesday that there was “an epidemic approaching” among people seeking detransition.

So, just how common are gender-affirming and gender-conforming care?

Agency for Health Care Administration data shows for Medicaid patients, at least, it’s not.

AHCA data provided to Florida Politics last year shows the number of adults and children receiving gender-affirming care and the care Medicaid reimbursed for the fiscal year (FY) 2017-18 through FY 2021-2022.

Data show that Medicaid reimbursed surgical procedures for just 12 children and 13 adults in FY 21-22 that. The most common procedure for both groups was a simple mastectomy, with three children and six adults undergoing the process sometime between July 1, 2021, and June 30, 2022.

Medicaid does not provide any benefits to children without parental consent. Children are defined as beneficiaries under 21 years of age, meaning the children category could include information on 18-, 19- or 20-year-old beneficiaries.

Medicaid covered the removal of the testes for two children and two adults and the amputation of a penis for one adult and one child. The safety net program for the poor, elderly and disabled also paid for the surgical construction of two artificial vaginas, one for a child and one for an adult.

Doctors performed 15 gender-affirming surgical procedures on 12 children, in addition to 19 on adults in FY 21-22.

AHCA supplied data that show 1,775 prescriptions for 15 minutes of behavioral therapy services were written for 233 children. Far fewer adults received such prescriptions, with 320 written for 33 adults in FY 21-22.

However, data show the number of children and adults receiving treatment has increased in recent years. For instance, in FY 2017-2018, 1,024 prescriptions for 15 minutes of behavioral therapy services were written for 143 children. Thirty-three adults received 320 prescriptions for the therapy services in the same year.

The data also show the number of children and adults receiving prescriptions for estrogen and testosterone increased in FY 21-22 from previous years. In 2021, 391 prescriptions for estrogen were written for 151 children compared to 185 prescriptions for 72 children in FY 17-18.

In FY 21-22, 233 adults received 688 estrogen prescriptions. By contrast, 148 adults received 392 estrogen prescriptions in FY 17-18.

More adults received written estrogen prescriptions than children, a data review shows. But the same is not valid for testosterone.

In FY 21-22, 346 children were given 925 prescriptions for testosterone. By contrast, 143 adults were written 373 prescriptions during the same period. Again, it’s an increase from FY 17-18 when 130 children were written 330 prescriptions and 63 adults were written 174 prescriptions.

Puberty blockers are only given to children. AHCA data show that 180 prescriptions for puberty blockers were written for 55 children in FY 21-22. That’s an increase from FY 17-18 when 15 beneficiaries received a combined 55 prescriptions.

 

— Fresh from Florida? —

Nearly one-third (32.1%) of 1 to 5-year-old children did not eat a daily fruit in 2021, and nearly one-half (49.1%) did not eat a daily vegetable during the preceding week. Yet a whopping 57.1% drank a sugar-sweetened beverage at least once during the preceding week, a new report released by the federal government shows.

And in Florida, the intake of fruits and vegetables was even worse. The Morbidity and Mortality report shows that 34.4% of Florida children aged 1-5 did not eat fruit daily and 52% reported not eating a vegetable daily during the preceding week.

Florida children were nearly on par with their peers nationally when it came to slurping down sugary drinks with 57.5% having ingested a surgery drink the preceding week had sugar-sweetened beverages.

Nationally, the percentage of children who did not eat a daily fruit or vegetable was higher among those who were aged 2-5 years, Black, or lived in households with limited food sufficiency. Similar patterns were seen for the consumption of sugar-sweetened beverages. State-level estimates for all three dietary practices varied widely. State-specific data was not provided.

There are four limitations with the report according to the authors. First, children’s dietary intake was reported by an adult who might not know everything a child ate. Second, frequency of intake was assessed, not the amount consumed; therefore, intake cannot be tied to a dietary recommendation. Third, information collection occurred in English or Spanish and might not represent families who speak other languages. Lastly, questions reflect intake during the preceding week and might not represent usual intake.

— RULES —

—The Board of Physical Therapy Practice proposes amending Rule 64B17-9.001 to update the number of CEUs that can be earned, per biennium, for being a Clinical Instructor for a Physical Therapy and Physical Therapy Assistant student. More here.

—The Board of Podiatric Medicine proposes amending Rule 64B18-17.001 Continuing Education Required for License Renewal. More here.

—The Board of Podiatric Medicine proposes amending Rule 64B18-17.002 to substantially rewrite regarding Board Approval of Continuing Education Programs. More here.

— ETC —

—West Central Florida, LLC. applied for an expedited CON from PruittHealth, Pruitt-Pinellas, to build a 120-bed nursing home.

— LOBBYISTS —

—Steve Crisafulli, Crisafulli Consulting: Florida Association of Health Plans

—Charles Dudley, George Feijoo, Floridian Partners: Florida Health Care Association, JES Holdings

—Natalie Kato: Healthcare Sterile Processing Association

—Christopher Schoonover, Capital City Consulting: Vaxxinity

—Heather Turnbull, Melissa Akeson, Kevin Comerer, Rubin Turnbull & Associates: Juul Labs, Millennium Physician Group.

—Evan J. Power Ramba Consulting Group LLC: American Medical Response, Florida Chiropractic Association, Florida Optometric Association, Florida PACE Funding Agency

As always, a hat tip to Lobby Tools.

— ROSTER —

— Allison Chavez was named the Associate State Director of Communications in Tallahassee, and Jill Auld was named the Associate State Director of Outreach & Engagement in Jacksonville. Chavez joined AARP Florida in 2023 as Associate State Director of Communications in the Tallahassee area. She is a strategic communications expert and a Tallahassee native. Auld joined AARP Florida in 2023 as Associate State Director of Outreach & Engagement in the Jacksonville area. She is a Jacksonville native and attended Florida State University, where she earned her master’s in social work; she is also a Licensed Clinical Social Worker.

— Jed Davis and AJ Dunn have been named to the Mayo Clinic Board of Trustees. Davis is President and CEO of DDI Inc., which operates the Davis Family Office headquartered in Jacksonville. Dunn is the Chief Administrative Officer of the Mayo Clinic in Florida.

— Matthew D. Disney, Ph.D. has been named the “institute professor” at The Wertheim UF Scripps Institute for Biomedical Innovation & Technology.

— ICYMI —

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

Transgender care becomes a legislative fight: Rep. Fine will be taking steps to prohibit physicians from providing minors access to transgender care, a move that would enshrine in law controversial restrictions recently put in place by the state’s two main medical boards at the urging of the DeSantis administration. Fine concluded a two-hour meeting Tuesday where he outlined plans to pursue legislation to ban the provision of gender-affirming or gender-confirming care to minors in the state. Fine told Florida Politics after the meeting that the bill will most likely be tailored to those under the age of 18.

Permitless carry and school safety? The Senate’s version of legislation to remove the requirement to get a permit to carry a concealed firearm includes a series of provisions aimed at beefing up school security. Republicans in favor of the bill (SB 150) still got a storm of condemnation from gun control advocates and gun rights supporters alike Monday as it passed through the Senate Criminal Justice Committee.

Skipping step therapy: A Senate panel approved a measure allowing Medicaid beneficiaries with serious mental illness to bypass “fail first” procedures, which require people to try less expensive options before “stepping up” to drugs that cost more. The Senate Health Policy Committee Monday passed SB 112 unanimously. Its counterpart (HB 183) has been referenced to the House Healthcare Regulation Subcommittee.

More, more more: The Florida Health Care Association’s (FHCA) legislative wish list includes pitches for more money and to expand the scope of practice for some certified nursing assistants (CNAs). Surprisingly, restricting lawsuits did not make the cut.

DeSantis unveils opioid settlement spend plan: More than $200 million from a multistate settlement in a lawsuit against opioid manufacturers could soon be flowing into Florida’s opioid abuse prevention and treatment programs, DeSantis said. “These were companies that knew that these were very highly addictive medications, and they were putting that out there without doing what they needed to do to protect consumers,” DeSantis said at an event in Destin.

— FOR YOUR RADAR —

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

—“Florida Surgeon General, again questioning COVID vaccines, sends letter to CDC, FDA” via Sam Ogozalek and Kirby Wilson of the Tampa Bay Times — Florida’s top health official sent a letter this week to the heads of the Food and Drug Administration and the Centers for Disease Control and Prevention warning that mRNA COVID-19 vaccines could be dangerous. It’s the latest instance of Surgeon General Joseph Ladapo, who runs the Florida Department of Health, questioning the safety of the vaccines. In the letter, he cites an increase in the number of reports from Florida submitted to the federal government’s Vaccine Adverse Event Reporting System, or VAERS, as evidence of a problem with the shots.

—“Florida abortions increased by thousands in 2022, fueled by out-of-state patients” via Caroline Catherman of the Orlando Sentinel — The number of abortions performed in Florida last year exceeded the two years prior — despite additional restrictions — as people from neighboring states increasingly traveled for care. In 2022, 82,192 abortions were reported in Florida, according to state Agency for Health Care Administration data. This is about 2,000 more than the year before and 7,000 more than 2020. More than 6,700 of the people who got abortions in Florida last year came from out-of-state, a 38% increase from 2021.

—“Horrific invasion of privacy,’ ‘antebellum-esque’: 150+ weighed in on menstrual questions” via Katherine Kokal of the Palm Beach Post — Draconian. Unnecessary. Shortsighted. Revolting. Those were the words from more than 150 people who signed up to speak their minds at Thursday’s meeting of the Florida High School Athletic Association’s board of directors where they discussed, and ultimately removed, questions about athletes’ menstrual histories from annual physical evaluation forms. People sent in comments admonishing the board for “invading” female athletes’ privacy. Some comments compared the moves to medieval times or communist countries. Their statements were at times profane, aggressive and personal toward the board members.

—“Huge influx’: Florida Capital Hospital hits record patient levels while TMH was offline” via Jeff Burlew of the Tallahassee Democrat — HCA Florida Capital Hospital saw a record influx of patients — even topping COVID-19 pandemic surges — during the nearly two-week-long cybersecurity incident at Tallahassee Memorial HealthCare. Capital Hospital, a 288-bed, acute care facility on Capital Medical Boulevard, normally runs at around 82% capacity with a daily census of around 200-220 patients. But that spiked to 117% and 338 patients — an all-time high — after the cybersecurity incident prompted TMH to divert patients elsewhere.

—“Florida assisted living home must pay $12.5 million after woman’s death” via Hannah Critchfield of the Tampa Bay Times — Last month, A Place to Grow was ordered to pay $12.5 million in damages in a wrongful-death lawsuit filed by [Nicole] Santos early last year. The complaint, filed in Hillsborough County, alleged that the facility was understaffed and negligent in caring for her mother, causing a preventable injury that led to her death. It may be the largest judgment awarded by a jury in a case involving a Florida assisted living facility, according to online legal research records.

— PENCIL IT IN —

Thursday

9 a.m. — The House Healthcare Regulation Committee will hear presentations from the Department of Health on the Office of Minority Health and Health Equity implementation update and the Florida Office of Insurance Regulation on the insurance market. The committee will also consider HB 33, HB 35, HB 117 and HB 139.

10 a.m. — The State Consumer Health Information and Policy Advisory Council meets. Agenda here. Register for virtual attendance here. Or attend in person at AHCA 727 Mahan Drive, Tallahassee.

1 p.m. — The Economic and Demographic Research Social Services Estimating Conference meets to discuss the FMAP rate. Room 112, Knott Office Building.

1:15 p.m. — The Social Services Estimating Conference meets to discuss KidCare expenditures. Room 112, Knott Office Building.

Sunday

Happy birthday to Rep. David Silvers.

Monday

Happy birthday to Rep. Angie Nixon.

Wednesday

2:30 p.m. — The Social Services Estimating Conference meets to discuss Medicaid expenditures and long-term expenditures. Room 112, Knott Office Building.

The Biomedical Research Advisory Council discussion regarding the 2023-2024 Funding Opportunity Announcement.

Diagnosis is written by Christine Jordan Sexton and edited by Drew T. Wilson.