Diagnosis for 3.22.23: 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.

— PDLs and PBMs —

While things appear to be moving at lightning speed, a high priority for Gov. Ron DeSantis, cracking down on pharmacy benefit managers (PBMs) won’t be heard in the House or Senate until next week.

In the meantime, there’s an opportunity to examine how the Medicaid program, which provides coverage to more than 5.4 million people, decides which drugs it offers. The Florida Medicaid Pharmaceutical & Therapeutics (P&T) is scheduled to meet Friday. The 11-member committee comprises five physicians, five pharmacists, and one consumer member (though that position is currently vacant).

Established in statutes, the P&T committee is charged with establishing the Florida Medicaid preferred drug list (PDL), which lists cost-effective, safe and clinically efficient medications that Medicaid enrollees can access without prior authorization. Drugs not on the PDL can still be prescribed, but those drugs may require prior approval.

In addition to determining which drugs appear on the Medicaid PDL, the P&T Committee also recommends to the state Agency for Health Care Administration (AHCA) which medications should require prior authorization. However, AHCA, not the P&T Committee, has the final say regarding drugs and prior approval.

A 10-member Medicaid Drug Utilization Review Board also reviews and approves drug-use criteria and standards for prospective and retrospective drug-use reviews. That board is slated to meet Thursday at 1:30 p.m.

___

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

— DeSantis’ other health care priorities —

Florida legislators have also been working quickly to move an extensive line of DeSantis’ top priorities this Session, including bills dealing with lawsuit limits, higher education, the death penalty and immigration.

But so far, they have not yet advanced the measures he asked for dealing with COVID-19 vaccines or a measure that would protect medical professionals who espouse opinions that are not in line with experts in the medical community.

DeSantis rolled out his “Prescribe Freedom” agenda in January, discussing taking steps to protect Floridians from the “biomedical security state.”

The list of measures the Republican Governor and likely presidential candidate wants to include permanent bans on vaccine and mask mandates in schools as well as a permanent prohibition on employer vaccine mandates and “vaccine passports” where a business requires proof of vaccination to serve a customer.

Legislators addressed many of these issues in previous regular and Special Sessions, but those requirements had sunset provisions and are scheduled to roll off the books this summer.

“We have rejected the biomedical security state in Florida and have provided protections for Floridians against unwanted medical interventions, but those protections are set to expire in July,” DeSantis said during his State of the State speech. “It’s important that we make all of these protections. Permanent protection from medical authoritarianism should not have an expiration date in the Free State of Florida.

DeSantis made his handling of the COVID-19 pandemic a cornerstone of his re-election campaign, and he’ll likely tout it during a potential presidential campaign. Republican legislative leaders have been in lockstep with DeSantis so far this Session, so it’s expected the bills will start moving soon.

— A ‘new normal?’ —

The House and Senate have unveiled their proposed health care spending plans this week, and — for what could be the first time in a decade — neither chamber has proposed slashing hospital budgets.

Hospitals have routinely faced reductions in their inpatient and outpatient Medicaid reimbursement rates.

After the Florida Hospital Association (FHA) released a study showing that the state was facing a looming nursing shortfall, the House released a proposed health care budget last year that pared back hospital payments by $259 million to help cover the costs of new nursing training programs. While the move was defeated, the proposed reductions the industry potentially faced were real.

But the 2023 Legislative Session is proving to be different.

Sen. Gayle Harrell and Rep. Sam Garrison released proposed spending plans this week and there was nary a cut in either.

The Senate’s proposed budget contains $76 million to increase payments to hospitals that treat medically complex pediatric patients. The Senate’s budget also proposed more than $123 million to increase graduate medical education (GME) to increase the number of physician residents in the state and train a future health care workforce to abate a projected physician shortfall in 2035. Of that $123 million, roughly $94 million will increase the number of physician residency slots in Florida hospitals.

Garrison told Florida Politics Wednesday that he isn’t making any “statement” regarding his proposed hospital spending plan.

“Every year’s budget is different. I think our focus this year is slightly different from last year, coming out of COVID. So, I think it’s a ‘new normal,’ Garrison said. “Our focus this year, especially on physicians, recruiting and training the best physicians and ensuring that children of working families are taken care of.”

— Speaking of physicians —

Florida Medical Association CEO Chris Clark hoped the 2023 Legislative Session was the year the statewide physician’s association wouldn’t have to worry about the so-called scope-of-practice bills.

He was wrong.

The House Healthcare Regulation Committee will deliberate the merits of HB 1067 Wednesday, which also happens to be CRNA Day at the Capitol.

Rep. Mike Giallombardo’s bill addresses a 2020 law that authorized autonomous practice for advanced-practice registered nurses (APRNs). An APRN is a licensed professional nurse who is additionally licensed in advanced nursing practice. APRNs include certified nurse midwives (CNM), certified nurse practitioners, certified registered nurse anesthetists (CRNAs), clinical nurse specialists and psychiatric nurses.

Championed by then-House Speaker José Oliva, the law gave the green light for APRNs to practice independently or autonomously from physicians. Still, it limited the care they could provide without supervision to primary care services, which effectively excluded CRNAs. CNMs who have a written referral agreement with a physician and a patient transfer agreement with a hospital are authorized to practice autonomously.

According to the staff analysis, there are currently 8,185 APRNs registered for autonomous practice in Florida.

HB 1067 eliminates the requirement in the current law that autonomous APRNs practice exclusively in primary care. In doing so, the bill gives the green light to CRNAs to practice without direct physician supervision.

More than 120 CRNAs are at the Florida Capitol advocating for the bill.

Meanwhile, the Florida Association of Nurse Anesthesiology has produced two videos that explain the importance of CRNAs in Florida’s health care delivery system. Check them out here.

— Managed care compliance —

The state has imposed $251,000 in liquidated damages for 19 breach-of-contract violations since Jan. 1.

The Agency for Health Care Administration (AHCA) website indicates that as of March 10, United Healthcare had more liquidated damages imposed against it ($74,500) than any other plan in the state for the third quarter of the fiscal year 2022-23. The damages were assessed for three contract violations.

Simply Healthcare also had three contract violations and AHCA imposed $60,500 in liquidated damages.

The plans account for nearly 54% of the liquidated damages levied against all plans in Q3 as of March 10. AHCA has levied $251,000 in liquidated damages against nine Medicaid managed care plans for 19 contract breaches.

The nine plans are: The CMS Health Plan; Community Care Plan; Florida Community Care; Humana Medical Plan; Molina Healthcare; Simply Healthcare; Sunshine Health; United Healthcare; and Vivida Health.

AHCA has imposed $733,000 in liquidated damages against 14 Medicaid managed care plans.

Florida Community Care has the dubious distinction of having the most contract breaches for FY 2022-23 with 13. The Medicaid managed care plan also received a $2,500 sanction for a contract violation. It is the only Medicaid managed care plan sanctioned for the year.

While Florida Community Care has the most contract breaches, United Healthcare has had the most liquidated damages ($140,500) imposed in the current fiscal year.

— RULES —

— AHCA proposes amending Rule 59G-4.002 to update the existing rule’s fee schedules and billing codes. The amendment revises the Florida Medicaid provider fee schedules and billing codes. More here.

— The Board of Chiropractic Medicine is amending its proposed Rule 64B2-13.004 regarding continuing education requirements for renewing active and inactive licenses. More here.

— LOBBYISTS —

Brian Ballard, Courtney Coppola, Adrian Lukis, Ballard Partners: CareSource Mission

David Browning, David Hagan, Nicole Kelly, Karis Lockhart, Erin Rock, The Southern Group: Bamboo Health, Calibrate Health

Michael Corcoran, Matt Blair, Will Rodriguez, Corcoran Partners: Kabompo Holdings

David Custin, David R. Custin & Associates: Florida Healthy Alternatives Association

James Eaton, Capital Strategies: Millennium Physician Group, The Special Committee for Healthcare Reform

Robert Holroyd, Tripp Scott: Quigley Health Services

Chante’ Jones: AARP

Christopher Snow, Snow Strategies: Children’s Care Campus

— ETC —

— The Florida Board of Medicine honors Florida State University College of Medicine student Decorian North as part of its Chair’s Medical Student Recognition Program. FSU College of Medicine Interim Dean Alma Littles nominated North. Scot Ackerman, M.D., Florida Board of Medicine Chair, approved the nomination. North, a Port St. Joe native, earned his undergraduate degree in biomedical science at FSU. He is currently studying at the Orlando Regional Campus and is slated to graduate in 2024.

— University of Florida College of Medicine students and faculty will be able to enroll in a new course at the end of April. A sneak peek of the course, titled Course II: A Basic Understanding of Coding for AI in Medicine, will be offered at the AI4Health conference in Orlando. Last year, more than 1,000 college affiliates enrolled in the first course on the fundamentals of artificial intelligence terminology and applications in medicine. The second course allows enrollees to hone their technical skills and builds upon what they learned from the first course. The college’s AI curriculum was developed by Francois Modave, Ph.D., a professor of AI in the department of anesthesiology; Christopher Giordano, M.D., chief of the division of liver and transplant anesthesiology and a professor of anesthesiology; and Patrick Tighe, M.D., M.S., the associate dean for AI application and innovation and the Donn M. Dennis, M.D., Professor in Anesthetic Innovation.

— Select Medical announced plans to build a new 63-bed specialty hospital to include critical illness recovery and inpatient rehabilitative care in Orlando’s Dr. Phillips suburb. “We have seen a tremendous growing need for post-ICU and inpatient rehabilitative care across the Central Florida region,” said Tom Mullin, executive vice president of hospital operations at Select Medical. As of Dec. 31, Select Medical operated 103 critical illness recovery hospitals in 28 states, 31 rehabilitation hospitals in 12 states, and 1,928 outpatient rehabilitation clinics in 39 states and the District of Columbia.

— ROSTER —

— DeSantis appointed Alex Anderson, Dr. Rosemary Laird, Jason Lederman, and Stacy Plean to the Alzheimer’s Disease Advisory Committee. The Governor reappointed Corinne Labyak and Dr. Jonathan Weiss to the Alzheimer’s Disease Advisory Committee.

— Senate President Kathleen Passidomo appointed Sen. Harrell to the Alzheimer’s Disease Advisory Committee.

— Baptist Health Miami Neuroscience Institute has hired Diego Torres-Russotto, M.D., to serve as the inaugural chair of the Neurology division. He joins Baptist Health Miami Neuroscience Institute from the University of Nebraska Medical Center (UNMC). He served as Professor, Chief of Movement Disorders and Vice Chair for Education with the department of Neurological Sciences.

— Cleveland Clinic Indian River Hospital has hired G. Dean Harter, M.D., as medical director for Orthopaedic Surgery. Before joining Cleveland Clinic Indian River Hospital, Harter was a clinical associate Professor at West Virginia University and Chief of Geisinger Shoulder and Elbow Institute at Geisinger Medical Center.

— Lee Health announced the slate of officers for its board of directors. Donna Clarke will serve as the chair, Therese Everly will serve as the Vice Chair, David F. Collinsas will serve as Treasurer, and Dane Allen will serve as the new board Secretary. They join the new Lee Health board of directors, David Klein and Daniel Adler.

— ICYMI —

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

— Future doctors: Florida faces a looming physician shortage as the population ages and health care needs increase. A Senate health care spending panel released a proposed budget for the fiscal year 2023-24 that would respond by pumping hundreds of millions of dollars into graduate medical education (GME) programs to train physicians and bolster the state’s workforce.

— Don’t even think about it: Battering or assaulting hospital employees or volunteers may not land assailants’ run-of-the-mill charges. Senate Health Policy Committee members voted unanimously to advance SB 568, sponsored by Sens. Ana Maria Rodriguez and Ed Hooper, to its following committee of reference. The bill elevates the charges that assailants can face for battery and assault on Florida hospital employees and volunteers.

— Mum on menstruation: Legislation moving in the House would ban discussion of menstrual cycles and other human sexuality topics in elementary school grades. The bill, sponsored by Republican Rep. Stan McClain, would restrict public school instruction on human sexuality, sexually transmitted diseases and related topics to grades 6 through 12. At a recent committee meeting, McClain confirmed that discussions about menstrual cycles would also be restricted to those grades.

— Rolling on along: A bipartisan bill allowing doctors in the Sunshine State to recertify medical marijuana prescriptions through telehealth is close to being greenlit in the House. The House Health and Human Services Committee voted unanimously to advance HB 387, extending the same prescription-renewal options available for other drug types to nearly 800,000 medical marijuana patients in Florida.

— No thanks: Accountable Florida published survey results from Metropolitan Research showing that most Floridians oppose legislation to protect insurance companies and businesses from lawsuits. The poll tested public opinion on several liability issues, with respondents consistently siding with protections for consumers instead of carriers. About 58% of voters said insurers should not be allowed to deny coverage if a motorcyclist rides without a helmet — which is legal under Florida law for those older than 21 — and is struck by another driver. Only 32% said they think insurance companies should be able to deny coverage.

— FOR YOUR RADAR —

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

—“Florida’s problems with mental health system flagged decades ago” via Sam Ogozalek of the Tampa Bay Times — Thousands of people struggle to access mental health services in Florida. The treatment system is disjointed and complex. Some residents bounce between providers and are prescribed different medications with clinicians unaware of what happened. Jails and prisons have become de facto homes for many who need care. These problems and more were identified in a scathing report released earlier this year by the Commission on Mental Health and Substance Abuse, a 19-person panel that Florida lawmakers created to push for reforms of the state’s patchwork of behavioral health services for uninsured people and low-income families. What’s most troubling about the group’s findings? They aren’t new.

—“COVID-19 politics leave an SW Florida public hospital shaken” via Patricia Mazzei of The New York Times — The turmoil at Sarasota Memorial, one of Florida’s most prominent public hospitals, began last year after three candidates running on a platform of “health freedom” won seats on the nine-member board that oversees the hospital. Board meetings, once sleepy, started drawing hundreds of angry people who, like the new members, denounced the hospital’s treatment protocols for COVID-19.

—“Bill would ban young girls from discussing periods in school” via Timothy Bella of The Washington Post — As Republicans are introducing and advancing a wave of bills on gender and diversity that are likely to be signed into law by DeSantis, one GOP lawmaker acknowledged this week that his proposed sexual health bill would ban girls from talking about their menstrual cycles in school. During a Florida House Education Quality Subcommittee hearing Wednesday, state Rep. Ashley Gantt questioned her Republican colleague, state Rep. Stan McClain, on his proposed legislation that would restrict certain educational materials used in state schools, which Democrats and critics have likened to banning books.

—“Orlando pastors spread the news of looming Medicaid loss to their communities” via Caroline Catherman of the Orlando Sentinel — The Rev. Sharon Riley is part of a growing number of church leaders who believe their duty to congregants doesn’t stop when they leave the pulpit. Within the last 10 to 15 years, church leaders, particularly in minority communities, have increasingly used parts of their budgets to share health resources and even create dedicated health ministries after observing health inequities, Riley said. Most recently, Riley and other pastors have taken on the responsibility of preparing their congregants for a looming change in Medicaid coverage.

—“Lawyers spar before a judge over rescinding federal approval of abortion pill” via Pam Belluck and Allison McCann of The New York Times — The first hearing in a closely watched lawsuit seeking to overturn federal approval of a widely used abortion pill concluded without a ruling, after more than four hours of pointed and emphatic arguments by both sides. Lawyers for the anti-abortion groups and physicians who had filed the suit claimed that the abortion pill was unsafe and that the Food and Drug Administration (FDA) had made mistakes in approving it. Lawyers from the Department of Justice, representing the FDA, cited evidence that the medication, mifepristone, was extremely safe and contended that the plaintiffs did not have any legal standing to file the lawsuit because none of them had any legal standing to even file the lawsuit because none of them could show that the FDA approval had caused them harm.

— PENCIL IT IN —

Thursday

It’s Florida Dental Hygienists’ Day at the Capitol.

8 a.m. — The Florida Board of Medicine’s Probation Committee meets. Join the virtual meeting here. Or call (571) 317-3112; participant code: 717632629.

8 a.m. — The House Judiciary Committee meets and will consider legislation (HB 87) requiring lactation spaces in courthouses and a proposed bill committee regarding human trafficking: Room 404, House Office Building.

8:30 a.m. — The Senate Fiscal Policy Committee meets and will consider SB 210 regarding substance abuse and SB 254 regarding gender-confirming and gender-conforming care: 412 Knott Building.

11 a.m. — The Florida Board of Medicine’s Council on Physician Assistants meets. Join the virtual meeting here. Or call (571) 317-3112; participant code: 717632629.

Noon — The House holds a floor Session.

1 p.m. — The Florida Boards of Medicine and Osteopathic Medicine’s Joint Surgical Care/Quality Assurance Committee meets. Join the virtual meeting here. Or call (571) 317-3112; participant code: 717632629.

1:30 p.m. — The Medicaid Drug Utilization Review Board meets to review and approve drug use criteria and standards for prospective and retrospective drug use reviews. The board will also recommend and evaluate educational intervention programs. Contact [email protected] for a copy of the agenda. Join the virtual meeting here.

2 p.m. — The Florida Board of Medicine’s Rules/Legislative Committee meets. The Florida Board of Medicine’s Probation Committee meets. Join the virtual meeting here.

2 p.m. — AHCA hosts a workshop on the development of proposed changes to Rule 59A-3.270 regarding health information management: AHCA, 2727 Mahan Drive, Tallahassee, Building 3, Conference Room B. Or call (888) 585-9008; participant code: 998518088.

Friday

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

8:30 a.m. — The Medicaid Pharmaceutical and Therapeutics Committee meets to recommend which drugs to include and exclude from the Medicaid preferred drug list. Contact [email protected] for a copy of the agenda. Join the virtual meeting here.

11 a.m.— The House holds a floor Session.

Monday

11:30 a.m. — The House Children Families & Seniors Committee meets: Room 102, House Office Building.

11:30 a.m. — The Senate Children, Families and Elder Affairs Committee meets: Room 37, Senate Office Building.

2 p.m. — The House Health & Human Services Committee meets: Room 404. House Office Building.

3 p.m. — The Senate Health Policy Committee meets: Room 412, Knott Building.

5 p.m. — Florida Gulf Coast University President Mike Martin and Members of the Tallahassee Alumni Chapter host an FGCU Day welcome reception at the Capitol.

Tuesday

Happy birthday to Attorney General Ashley Moody.

Happy birthday to Rep. Vicki Lopez.

The Florida Dental Association hosts 2023 Dentists’ Day on the Hill — Freedom to Smile!

8 a.m. — The House Appropriations Committee meets: Room 212, Knott Building.

9 a.m.— The Senate Appropriations Committee meets: Room 412, Knott Building.

2 p.m.— The House Healthcare Regulation Committee meets: Room 102, House Office Building.

4:30 p.m. — The Youth Art Exhibit and Silent Auction to benefit the Florida Youth Foundation: LeMoyne Arts, 125 N. Gadsden St., Tallahassee.

Wednesday

It’s Miami-Dade County Days in Tallahassee.

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

11:30 a.m.— Paella Fest in the Capitol Courtyard.

3:30 p.m. — The Senate holds a floor Session.

7 p.m. — A Taste of Hialeah at Mambo Kings Pig Roast in Kleman Plaza.