Diagnosis for 3.16.23: 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.

— Transcare rule takes effect —

The Board of Medicine’s rule banning nearly all gender-affirming care for minors goes into effect Thursday.

The rule, first published in the fall, bans surgeons from performing sex reassignment surgeries on minors, or any other surgical procedures that alter primary or secondary sexual characteristics. It also prohibits physicians from treating minors with gender-blocking hormones, a position advocated by Florida Surgeon General Joseph Ladapo.

The new rule comes after state Medicaid officials moved to ban the safety net program for the poor, elderly and those who are disabled from providing reimbursement for gender-affirming care. That decision faces a challenge in federal court.

The Agency for Health Care Administration previously provided Florida Politics data showing that very few Medicaid beneficiaries in Florida have received gender-affirming care.

A similar rule approved by the state Board of Osteopathic Medicine is scheduled to go into effect later. The lag time is due to the Board initially supporting a rule that differed significantly from the one OK’d by the Board of Medicine.

The first version would not have banned osteopathic physicians from prescribing gender-blocking hormones, but the board later changed its position to match the Board of Medicine’s, which required to push back the effective date.

Both the Board of Medicine rule and the Board of Osteopathic Medicine rule will allow minors being treated with puberty-blocking hormones before the rules take effect to continue receiving the treatment.

The rule goes into effect as the Republican-dominated state Senate is advancing legislation (SB 254) that would criminalize child sex reassignment treatments and make such treatments a reason for the state to seize a child from parental custody.

Additionally, the bill would only allow medical doctors and osteopathic physicians to provide gender-affirming care, a provision made moot for minors due to the ban via rules.

Still, that portion of the bill would seemingly block physician assistants and advanced registered nurse practitioners from providing gender-affirming treatments to adults, which is permitted under current law.

Republican Reps. Randy Fine and Fred Massullo are sponsoring a related bill in the House (HB 1421), but that legislation focuses on birth certificate changes, clinical practices and insurance payments.

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— Good news for state employee insurance —

New estimates for Florida’s state group health insurance program show that the financial outlook has improved in the short term, but significant deficits are looming.

Members of the estimating conference that evaluates the insurance program released a new forecast this month that shows the program will only have a $4.1 million deficit in June 2024, when the next fiscal year ends. That’s a substantial downward revision from last August when economists predicted a nearly $170 million deficit. There are multiple changes for the revision, but enrollment isn’t increasing as much as estimators previously expected.

The estimates show that about 167,000 employees and retirees are covered now, which will rise to slightly more than 168,000 in the fiscal year starting July 1.

But the small deficit projected for the 2023-24 fiscal year is expected to balloon to $742 million by the middle of 2025 and get as big as $1.55 billion three years later. Economists warned that the deficits would continue to mount even if legislators try to clear them annually.

State legislators for years have avoided raising health care insurance premiums for employees and instead have increased state spending on the program to prevent deficits. Last year, the state pumped an extra $200 million into the trust fund to cover the program costs.

The substantially smaller 2023-24 deficit in the revised forecast lowers pressure on legislators to make any significant changes during this year’s Legislative Session. But it’s a problem that they may have to address in 2024.

— Settlement over Healthy Kids breach —

A Tallahassee-based company and its manager and co-owner have agreed to pay nearly $294,000 to settle allegations that they failed to protect personal information on the Florida Healthy Kids website.

According to the U.S. Department of Justice, Healthy Kids suffered a mammoth data breach in December 2020 when more than 500,000 applications submitted on HealthyKids.org were hacked, creating a risk that applicants’ personal identifying information and other data was exposed.

“Government contractors responsible for handling personal information must ensure that such information is appropriately protected,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in a statement. “We will use the False Claims Act to hold accountable companies and their management when they knowingly fail to comply with their cybersecurity obligations and put sensitive information at risk.”

The state hired Jelly Bean Communications Design LLC in 2013 for website design and hosting services. Jeremy Spinks, the manager and 50% company owner, signed the agreement.

Between 2013 and 2020, Jelly Bean maintained the Healthy Kids website, including the online application that families used to apply for coverage for children. The settlement between the company and federal authorities resolves allegations that, over six years, Jelly Bean did not provide secure hosting and knowingly failed to maintain and update software systems used for the Healthy Kids website.

Jelly Bean does not admit liability in the settlement agreement.

— Another player in PBM fight —

There’s a new player in the push to crack down on pharmacy benefit managers (PBMs) in Florida: The PBM Accountability Project of Florida.

Members include the Florida Medical and Florida Osteopathic associations, Seniors Across America and Christian Family Coalition Florida.

The group announced its formation Wednesday, sending out a news release throwing its support behind SB 1550 by Sen. Jason Brodeur and HB 1509 by Rep. Linda Chaney.

The Senate bill has been referred to the Health Policy and Fiscal Policy committees. The House bill has been referred to the Healthcare Regulation, Appropriations and Health & Human Services committees.

At press time, neither the Senate nor the House bill was heard in committee or even scheduled for a hearing.

“Already, Florida’s seniors are dealing with the increasing impacts of inflation. They simply cannot afford the additional financial strain of higher drug prices driven by PBM greed,” said former State Sen. John Grant, President of Seniors Across America and member of The PBM Accountability Project of Florida. “Senior citizens, especially those on a fixed income, often struggle to pay for the medications they depend on for their health and quality of life — it’s time we change that. Our seniors deserve better, and by working together, we can form common-sense policy that will benefit all Floridians.”

Gov. Ron DeSantis has made reining in PBMs a top priority for the 2023 legislative Session.

Specifically, The PBM Accountability Project of Florida wants the Legislature to prohibit PBMs from requiring consumers to use PBM-owned pharmacies and mail-order houses. The PBM Accountability Project also wants the Legislature to require PBMs to report information to the state about how much money they spend on acquiring pharmaceuticals.

— Rest in peace —

Sam Bell, a well-known political and lobbying fixture, and part of a Democratic political dynasty in Florida, died Tuesday night during emergency surgery. He was 88.

Bell spent 14 years in the state Legislature and served as the top budget writer in the House for four years. Bell was on the cusp of becoming House Speaker when in 1988, a Republican challenger upset him. Recalling the loss 25 years later, Bell lamented to the News Service of Florida, “I think I could have made a difference, and I regret not having that opportunity.”

While he was denied the opportunity to run the Chamber, Bell nonetheless left a legacy, especially regarding Florida’s health care policy. He helped establish the Florida Healthy Kids program and the University of South Florida Morsani College of Public Health.

He is the “core foundational giant to whom I owe much of what I’ve done, been ‘allowed’ to (do),” Jay Wolfson, USF Associate Dean and a distinguished professor, said in a text. More here.

— RULES —

— The Board of Dentistry proposes amending Rule 64B5-16.005 regarding supervising dental assistants in a program and delegating dentists’ responsibilities. More here.

— The Board of Hearing Aid Specialists proposes amending Rules 64B6-6.002, 64B6-6.008, 64B6-6.009 and 64B6-6.010 to comply with federal regulations. More here.

— LOBBYISTS —

Keith Arnold, J. Keith Arnold & Associates: St John Bosco Clinic

Leah Barber-Heinz: Susan G. Komen

Wilbur Brewton, Brewton Plante: Choice Plus

Matt Bryan, Teye Carmichael, David Daniel, Jeff Hartley, Lisa Hurley, Jonathan Rees, Smith Bryan & Myers: Florida Association of Nurse Anesthesiology

Claudia Davant, Adams St. Advocates: AllHealth CHOICE, First Coast Health Solutions, Florida Pharmacy Association, HealthPlan Data Solutions, Mental Health Association in Indian River County, Quidel Corporation

Candice Ericks, Ericks Consultants: Retreat Behavioral Health

Mercer Fearington, Nicole Kelly, Karis Lockhart, Sydney Ridley, Kaley Slattery, The Southern Group: Florida Senior Living Association

Carol Gormley: Florida Community Care, Independent Living Systems

Shaddrick Haston: Florida Assisted Living Affiliation

Robert Henderson, Daniel Olson, Meenan: MetLife

Douglas Mannheimer: Florida Health Care Association

Christian Minor, Elnatan Rudolph, Converge Public Strategies: Florida Chiropractic Society

David Ramba, Evan Power, Ramba Consulting Group: Florida Healthy Alternatives Association

Frank Terraferma: Pediatric Associates, Pulsara

— ETC —

— HCA Florida Gulf Coast Hospital opened a new free-standing emergency room in Panama City Beach at 9318 Panama City Beach Parkway. The 11,000-square-foot facility provides a full range of medical services for children and adults.

— The Florida State University College of Nursing is the top-ranked nursing program in Florida that receives funding from the National Institutes of Health Blue Ridge Institute for Medical Research. BRIMR rankings also show that FSU’s College of Nursing ranked No. 8 nationally among all schools or hospitals with nursing programs and No. 5 among public institutions.

— ROSTER —

— Nima Sharifi, M.D., is the new scientific director of the University of Miami Miller School of Medicine’s Desai Sethi Urology Institute. In that role, Sharifi will collaborate with the Sylvester Comprehensive Cancer Center to drive translational science focused on prostate and other genitourinary cancers.

— Bailey Smith is joining the state Agency for Health Care Administration’s communications team. Before joining AHCA, she served in DeSantis’ communications offices.

— Steven Travers is the new Chief Information Officer for Broward Health. As CIO, Travers will oversee and manage information systems, medical review systems, office automation and data telecommunications.

— Richard Follwell is joining the Palm Beach Health Network Physician Group, where he will open a bariatric and general surgery practice in Palm Beach Gardens. Follwell is board-certified by the American Osteopathic Board of Surgery and has rejoined the staff at Good Samaritan Medical Center in West Palm Beach.

— ICYMI —

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

— Final form? The chambers agreed that the changes should not impact medical malpractice cases or wrongful death cases against physicians. “I hold doctors to a higher standard,” Hutson said of maintaining current law for medical malpractice cases. The chambers also compromised on so-called “truth in medical damages” and letters of protection (LOP). The agreement between the chambers addresses both past and future medical bills. Specific to past bills, the deal allows jurors to see the amount paid to settle the bills regardless of the payment source. Regarding future medical bills, the agreement enables the jury to see evidence depicting the amount necessary to satisfy unpaid charges for incurred medical treatment.

— The Great Unwinding: As Florida begins to unwind from the public health emergency and returns its Medicaid program to pre-pandemic rules, there’s a move underway to expand income eligibility for a subsidized children’s health insurance program. Florida Healthy Kids Corporation (FHKC) staff met with Renner to discuss expanding the income eligibility for the state children’s health insurance program, Florida KidCare. That would allow more children in low-income families to qualify, FHKC Chief Executive Officer Ryan West said.

— Court intervention: Jacksonville Republican Sen. Clay Yarborough’s SB 254 would give the state temporary emergency authority over children if they are at risk or are getting what some call “gender-affirming care” and others call “sex-reassignment” prescriptions or procedures. In addition, it would require health care providers to say they don’t provide the treatment to children younger than 18 or face losing their license. Yarborough’s amendment allows the state’s courts broad discretion about when and how to intervene in gender-affirming treatment when one parent supports it, and the other does not.

— Clots kill: A House spending panel is giving the nod to a bill that creates a pulmonary blood clot and embolism policy work group to determine how many people in Florida are impacted by clots. These numbers are only estimates because currently, there is no systematic collection of blood clot-related morbidity or mortality data in the United States. The bill (HB 483), filed by Rep. Dean Black, creates the Emily Adkins Prevention Act. The measure establishes a work group composed of providers, patients, family members, health care associates, and advocates. It authorizes the House Speaker and Senate President to each appoint two members. The state Surgeon General can appoint the work group Chair.

— High impact: A new study from Florida State University (FSU) shows Humana has a $48 billion economic impact in the Sunshine State. The FSU study shows that, as an employer, Humana was responsible for $18 billion in income or wages and $472 million in state and local taxes last year. Going forward, Humana’s economic impact is projected to grow significantly as they continue to invest in Florida’s residents and workforce. The FSU report projects the company will have a $64.6 billion impact — including $35.3 billion on personal incomes — in 2035. That economic output will support nearly 259,000 jobs in the health care sector.

— Burst bubbles: What groceries people buy and their role in society’s ills came under lengthy debate, as a House Memorial advanced asking the feds to prohibit soda purchases with government food assistance. But that did not go down easily with Democrats united against the measure (HM 581) filed by Republican Rep. Ralph Massullo. He brought his authority as a doctor to champion the effort in front of the House Children, Families and Seniors Subcommittee. The memorial would put the House on record with a request to add soft drinks to the list of items that can’t be purchased using federal Supplemental Nutrition Assistance Program (SNAP) funds.

— FOR YOUR RADAR —

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

—“Rape victims must show proof to get an exception under Florida’s six-week abortion ban” via Skyler Swisher of the Orlando Sentinel — Floridians who are raped would need to show evidence of that crime if they want an exception under the Legislature’s proposed six-week abortion ban, a requirement that advocates say would traumatize victims of sexual violence even more. Victims of rape or incest must provide a copy of a restraining order, police report, medical record, or court document to obtain an abortion after six weeks of pregnancy. Rape and incest exceptions would end at 15 weeks of pregnancy. Jennifer Dritt, executive director of the Florida Council Against Sexual Violence, said lawmakers didn’t consult with her group representing 29 rape crisis centers across the state when crafting the bill’s language.

—“CDC, FDA send letter to Florida’s Surgeon General warning he is endangering lives with COVID-19 vaccine risk advice” via Cindy Krischer Goodman and Caroline Catherman of the South Florida Sun-Sentinel — U.S. public health agencies sent a letter to Florida Surgeon General Ladapo warning that his fueling of vaccine hesitancy is harming the public, particularly Florida seniors. The U.S. FDA and the CDC want Ladapo to stop disproportionately focusing public attention on the few instances of adverse effects from the COVID-19 vaccine. They urge him to recognize that more than 13 billion doses of COVID-19 vaccines have were administered worldwide “with little evidence of widespread adverse events.”

—“Florida universities provide little gender-affirming care, reports show” via Divya Kumar of the Tampa Bay Times — Gender-affirming health care makes up a fraction of the caseloads in medical facilities run by Florida’s public universities, according to records that DeSantis’ budget office ordered the schools to turn over in January. The order has been a topic of high interest across the state, inspiring student protests and frequent remarks by the Governor. “You’re talking about publicly funded institutions,” DeSantis said at a Jan. 31 news conference in Bradenton, laying out his rationale for the request. “Those are not things that I think are an appropriate use of your tax dollars.”

—“Why did several nurses get fired from MCR Health? Bradenton-based nonprofit won’t say” via James A. Jones Jr. of the Bradenton Herald — Several health care workers are calling foul after MCR Health, a not-for-profit health care system based in Bradenton, sent them letters of termination. Just how many lost their jobs — or why — MCR Health is not saying. But several nurses let go reached out to the Bradenton Herald and said it could be 20 or more. “Most were upper-level employees,” said Kendra Cannon, who received a termination letter while working as a charge nurse. “No one in my immediate leadership knew that this was going to happen. Most of those let go were way higher than me,” Cannon said. Cannon was not given a reason for her separation.

—“A hearing on COVID-19’s origins spurs call for rules to curb risky virus research” via Riley Griffin and Alexander Ruoff of Bloomberg — The Trump administration’s top infectious disease official urged lawmakers during a hearing on the origins of the COVID-19 pandemic to ban research that enhances a pathogen’s ability to spread or cause disease. Robert Redfield, who served as the director of the CDC at the outset of the health crises, has long maintained that COVID-19 was likely from a lab accident in Wuhan, China.

—“Florida teens shouldn’t start school too early; lawmakers want to do something about it” via Danielle J. Brown of the Florida Phoenix — Almost half of public high school students in Florida start their school day before 7:30 a.m., although years of studies showing later start times are better for teens. Now, lawmakers want to amend the school day hours. Renner mentioned the issue during his opening remarks at the start of Session. “Quality sleep is also critical to children’s learning and mental health, so we will pursue appropriate school start times as a zero-cost way to improve both academic scores and mental well-being,” Renner said. Now, there’s proposed legislation (HB 733/SB 1112) says by July 1, 2026, Florida middle schools cannot start classes earlier than 8 a.m., and high school classes cannot begin earlier than 8:30 a.m.

— PENCIL IT IN —

Thursday

Happy birthday to Rep. Chip LaMarca.

It’s also Florida Hospital Association’s Hospital Days at the Capitol.

Friday

Happy birthday to Rep. David Smith.

8 a.m. — The House Health & Human Services Committee meets: Room 17, House Office Building.

10:30 a.m. — The House holds a floor Session.

Monday

12:30 p.m. — The Senate Children, Families, and Elder Affairs Committee meets. Place: 37 Senate Office Building.

3:30 p.m. — The Senate Health Policy Committee meets.

Tuesday

Happy birthday to House Speaker Paul Renner.

8:30 a.m. — The Senate Appropriations Committee on Health and Human Services meets: Room 412, Knott Office Building.

9 a.m. — The House Children Families & Seniors Committee meets: Room 102, House Office Building.

10 a.m. — GO NOLES! It’s FSU Day at the Capitol.

4 p.m. — Registration for Broward Days begins: 101 S. Adams Street. More details here.

Wednesday

8 a.m. — The House Health Care Appropriations Subcommittee meets: Room 17, House Office Building.

Full committee agendas, including bills to be considered, are available on the House and Senate websites.