Diagnosis for 4.12.23: 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.

— KidCare gets Senate love —

The Senate is poised to go along with House Speaker Paul Renner’s push to, for the first time in 25 years, expand eligibility for the Florida KidCare program.

While the House had been moving its proposal (HB 121) and included funding for the expansion in its budget, the Senate was not fast-tracking the companion bill, SB 246 by Sen. Alexis Calatayud.

Senate Health and Human Services Appropriations Committee Chair Gayle Harrell said she hadn’t scheduled the bill for consideration because she was taking a close look at the proposal to ensure they had the money to fund the expansion.

She told Florida Politics earlier this month, “I am looking very seriously at it and if we can find the dollars, I am amenable to doing it.”

On Wednesday, Harrell’s committee considered the bill and approved an amendment making it identical to the House counterpart before voting to unanimously advance it to the Senate Fiscal Policy Committee.

Before the vote, Harrell thanked Calatayud for sponsoring what she called a “tremendous bill.”

“We’ve had to make sure we had enough resources to do this, and I think it’s a great step forward for our children and our families,” she said.

Florida Healthy Kids Corporation Board of Directors Chairperson Stephanie Haridopolos told Florid Politics, “I am beaming with joy right now.”

Now that Renner’s health care priority is advancing in the Senate, it appears the House is moving Senate President Kathleen Passidomo’s health care priority (SB 230) dealing with titles that health care providers can use. The House moved its version of the measure (HB 583) last week. Additionally, one of the committee references for the House bill was removed.

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— Exemptions —

Not all health care services are treated equally under a bill that allows health care providers and insurers not to provide care or reimbursement for services when they have moral or religious objections.

HB 1403 broadly defines health care providers to include mental health providers, EMTs, physicians, nurses, chiropractors, podiatrists, optometrists, pharmacists and pharmacies, massage therapists and clinical counselors, among others.

Nursing homes, hospices, intermediate care facilities for the developmentally disabled, and home medical equipment providers also are included in the definition.

Before voting to advance the bill Monday, members of the House Health and Human Services Committee tagged on an amendment specifying that the opt-out provisions don’t apply to the long-term care industry, nor does it apply to insurers when it comes to life-supporting care or life-sustaining care equipment necessary for the restoration or continuation of a bodily function important to the continuation of human life.

That list of equipment includes enteral feeding pumps, infusion pumps, portable home dialysis equipment, and ventilator equipment and supplies such as oxygen.

— Fixing auto assignment woes —

The Agency for Health Care Administration’s third Medicaid managed care procurement is officially underway.

AHCA finally dropped the invitation to negotiate (ITN) for the procurement process this week. Included in the lengthy document is a section that changes how the state assigns people to contracted managed care plans if those people don’t voluntarily select which plan to join.

The change could help ensure the viability of managed care plans — including provider-sponsored networks (PSNs) — that are new to Florida’s Medicaid managed care program.

The ITN makes clear that any new managed care plan in a region is guaranteed to get at least 30% of an exiting plan’s enrollees who did not voluntarily make a choice of plans. The remaining 70% of the exiting plan’s enrollment would then be divided up among the rest of the plans in the region.

Let’s assume there are three Medicaid managed care plans in a region, each with 120,000 members, and AHCA offers contracts to two of the three plans but brings in a new, third plan.

The 120,000 members who belong to the exiting plan are first given the opportunity to voluntarily choose which of the three plans to join. If 20,000 members make a choice the state must auto-assign the remaining 100,000 members. The new ITN requires that 30% of those 100,000 members (or 30,000 people) be auto-assigned to the new health plan in the Medicaid region. Then the remaining 70,000 would be divided evenly among the three plans. In that scenario, the new plan would have about 53,000 members, which would be enough to keep it afloat and operating in the market.

That was not the case with the second procurement. AHCA relied on an algorithm that was designed to promote continuity of care, which meant family members were enrolled in the same plan as one another. The algorithm was also designed so beneficiaries were enrolled in plans they had prior relationships with.

The auto-assignment process worked against new entrants into the Medicaid managed care marketplace. There were attempts to alter the algorithm to help bolster enrollment in newly contracted plans, but they were not successful.

Ultimately, three PSNs that AHCA contracted with following the second procurement — Lighthouse Health Plan in the Panhandle; Vivida Health in Southwest Florida; and Miami Children’s Health Plan in South Florida — were all bought by Simply Health Care.

— Something to watch —

As soon as the Florida Legislature passes the halfway point of the Session the pressure to get a bill over the finish line ratchets up. So, when a bill that’s scheduled to be considered in committee suddenly falters it raises questions about whether it will go the distance.

Case in point: Sen. Jason Brodeur temporarily postponed a measure (SB 268) on Wednesday that deals with hospital and ambulatory surgical center debt and charges. The bill prohibits certain billing and debt collection practices and limits to three years the length of time a hospital or ambulatory surgical center must collect the debt.

The bill also requires hospitals, ambulatory surgical centers and insurers to provide patients with certain cost information.

The legislation is supported by insurers or hospitals because parts of it are duplicative of federal law.

The legislative analysis of the bill contends that it will have “an indeterminate negative fiscal impact on hospitals, ASCs and health insurers” to meet the requirements in the legislation because of the potential limits on collecting medical debt.

It’s also unclear how much the legislation, which puts new requirements on hospitals and ambulatory surgical centers, will cost the state to enforce. That’s because AHCA, which regulates those entities, did not prepare a fiscal analysis for the bill.

— In the air tonight —

The American Lung Association in Florida will release its 24th annual “State of the Air” report next week.

The report tracks Americans’ exposure to unhealthful levels of ozone and particle pollution and ranks U.S. cities nationwide from the cleanest to most-polluted air quality.

It will also highlight how many people are living with and breathing polluted air, placing their health and lives at risk.

The report will highlight the air quality in the Miami area and the actions residents and local, state and national leaders can take to improve air quality. Stay tuned.

— RULES —

— The DOH Division of Medical Quality Assurance proposes updating Rule 64B-9.001 to update the application form and renewal schedule for health care practitioner licenses to add genetic counselors. More here.

—The DOH Division of Medical Quality Assurance proposes updating Rule 64B-9.009 to provide for registration for exemption from licensure for a person fulfilling an occupational therapy doctoral capstone experience that involves clinical practice or projects. More here.

— The Board of Psychology proposes amending Rule 64B19-11.005 to update the requirements for supervised experience. More here.

— AHCA is proposing to create rule 59A-8.0248 to create the “Excellence in Home Health Program,” which is designed to award well-performing home health agencies based on survey performance and other criteria. More here.

— The Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling proposes amending Rule 64B4-3.0085 to update the rule language and applications for intern registration. More here.

— The Board of Speech-Language Pathology and Audiology proposes amending Rule 64B20-8.008 on what information must be included on receipts. More here.

— The Board of Speech-Language Pathology and Audiology proposes amending Rule 64B20-8.009 on a 30-day trial period; purchaser’s right to cancel; notice; refund; and cancellation fee. More here.

— LOBBYISTS —

Steven Geller, Geller Law Firm: OSCR, Professional Opticians of Florida

Ashley Lyerly: American Lung Association

Craig Saperstein, Pillsbury Winthrop Shaw Pittman: Professional Certification Coalition

— ETC —

— AHCA on April 7 approved PruittHealth-Pinellas LLC’s expedited CON application to transfer certificate of need (CON) application 10667 to PruittHealth West Central Florida to build a 120-bed community nursing home. The decision is not final and can be challenged but notice must be provided to AHCA within 21 days of the decision. More here.

— CON applications were filed with AHCA for hospice programs. VITAS Healthcare Corp. of Florida filed a CON application for a program in Franklin County. ARC Hospice of Florida sent a CON application for a program in Alachua County. More here.

— ROSTER —

—Nicklaus Children’s Health System has named Kevin Snyder vice president of marketing and communications.

— Dipen J. Parekh, M.D., was elected to the American Association of Genitourinary Surgeons (AAGUS), an organization of leading academic urologists. Parekh is the founding director of the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine.

— Sonya Kaur, Ph.D., an instructor of neurology at the University of Miami Miller School of Medicine’s Division of Neuropsychology, has been selected as a junior faculty scholar in the Alzheimer’s Disease Neuroimaging Initiative (ADNI).

— ICYMI —

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

— Opting out: Despite concerns that the bill (HB 1403) could allow physicians to discriminate against female, gay, transgender and minority patients, members of the House Health and Human Services Committee voted 11-5 Monday afternoon to approve the bill.

— And so it begins: Florida is finally moving ahead with a mammoth series of contracts that will control the future of the state’s $38 billion Medicaid program and how care is delivered to the millions of poor or disabled residents who rely on the program. The long-awaited invitation to negotiate (ITN) released Tuesday by the state Agency for Health Care Administration (AHCA) puts an increased emphasis on the delivery of behavioral health services and, according to the ITN, the agency intends to award contracts to “nationally accredited plans that offer an enhanced delivery systems and integration of integration of behavioral and physical health services.”

— Helping DeSantis secure the White House?: The head of the Florida Democratic Party contends that legislation (SB 300) to change Florida’s current 15-week abortion ban to six weeks is an example of a policy that could help Gov. Ron DeSantis’ run for the White House. “If there was any question about whether Ron DeSantis is in lockstep with anti-choice extremists pushing a nationwide abortion ban, this latest endorsement answers it,” Fried said. This “latest endorsement” comes from anti-abortion Susan B. Anthony Pro Life America. The group’s Vice President of Communications contends the legislation “could only help DeSantis become President” and that the Governor “has his finger on the people’s pulse with this bill.” Those assertions run counter to polling showing that a majority of Floridians favor abortion access.

—Restrictions ahead: A House committee is moving legislation that would impose regulations on hemp products including banning the sale of hemp on anyone under age 21. It also sets up requirements for containers, including showing that they are “suitable to contain products fit for human consumption,” mitigate exposure to light and high temperatures, and aren’t designed to be “attractive to children.”

—Pregnant prisoners: Legislation that would guarantee some rights to pregnant prisoners advanced through its second House committee this week. The House Justice Appropriations Committee voted 14-1 to approve the legislation (HB 779) from Reps. Dianne Hart and Angie Nixon. It’s called “Ava’s Law,” in honor of a newborn who didn’t get the benefits that the law would provide, Hart explained. The bill would allow judges to defer a pregnant woman’s incarceration for up to 12 weeks after delivery. Also, under the bill, detention facilities would have to supply pregnancy tests upon request for arrestees detained longer than 72 hours. The Senate counterpart has yet to be heard.

— FOR YOUR RADAR —

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

“Health officials removed key data from COVID-19 vaccine report” via Christopher O’Donnell of the Tampa Bay Times — Florida Surgeon General Joseph Ladapo announced in October that young men should not get the COVID-19 vaccine, guidance that runs counter to medical advice issued by the CDC. Now, draft versions of the analysis obtained by the Tampa Bay Times show that this recommendation was made despite the state having contradictory data. It showed that catching COVID-19 could increase the chances of a cardiac-related death much more than getting the vaccine.

“Two friends were denied care after Florida banned abortion. One almost died.” via Caroline Kitchener of The Washington Post — Florida’s abortion law, enacted last year, bans the procedure after 15 weeks of pregnancy except when an abortion would either “save the pregnant woman’s life” or “avert a serious risk of substantial and irreversible physical impairment of a major bodily function.” The law includes another exception for a “fatal fetal anomaly,” which generally would not apply in a pre-viability PPROM case, according to several doctors, because there is no fetal anomaly but a lack of amniotic fluid, which limits the fetus’s chances of survival. The condition is common enough that one day after Anya Cook was turned away from the hospital, the same thing happened to one of her closest friends. Shanae Smith-Cunningham, 32, was 19 weeks into her pregnancy when her water broke.

“As Central Florida gun violence escalates, pediatricians call for public health over politics” via Caroline Catherman of the Orlando Sentinel — Orlando Health Arnold Palmer Hospital for Children treats victims of gun violence ages 15 and under from across the region. Pediatric Trauma Director Dr. Don Plumley estimates Arnold Palmer sees a child with a gunshot wound about once a week. The American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, and the American Psychiatric Association have for years advocated for a public health approach. “Gun violence should be considered a public health issue, not a political one — an epidemic that needs to be addressed with research and evidence-based strategies that can reduce morbidity and mortality,” reads a joint statement.

“Mother can give COVID-19 to fetus, causing brain damage, UM case study shows” via Jesse Scheckner of Florida Politics — A new case study from the University of Miami (UM) Health System and the school’s Miller School of Medicine is showing that COVID-19 infection can breach the placenta during pregnancy and cause brain damage in a newborn. UHealth found two such cases at the Neonatal Intensive Care Unit (NICU) at Holtz Children’s Hospital, a teaching hospital affiliated with the university and Millers School. In both cases, the mothers contracted the infection in their second trimester and cleared the virus; however, one had a repeat infection in her third trimester, suggesting an unusual maternal and/or fetal immune response may have been a factor.

“$175,000 awarded to ‘conversion-therapy’ providers in Boca Raton case” via Rafael Olmeda of the South Florida Sun-Sentinel — A federal judge has ordered Palm Beach County and the City of Boca Raton to pay $175,000 to two family counselors who challenged a local ban on “conversion therapy” for minors struggling with their sexuality, gender identity and faith. Robert Otto and Julie Hamilton ran afoul of Boca Raton’s ban on the practice, which considered it to be harmful to the health and emotional development of lesbian, gay, bisexual, transgender and other youth. A district court upheld the law, but Otto and Hamilton appealed, backed by religious-liberty advocates at Liberty Counsel.

— PENCIL IT IN —

Thursday

Happy birthday to Chief Financial Officer Jimmy Patronis.

Happy birthday to Rep. John Snyder.

Happy birthday to Rep. Sam Killebrew.

It’s FAMU Day at the Capitol.

8:30 a.m. — The Senate Health Policy Committee will consider the confirmation of AHCA Secretary Jason Weida.

9 a.m. — House session. The House will be considering a six-week ban on abortion (SB 300) as well as a bill (HB 121) to expand income eligibility for the KidCare program.

10:30 a.m. — The Senate Fiscal Policy Committee will consider a number of health-care-related bills including SB 112 regarding step therapy protocols and SB 1560, Brodeur’s bill on pharmacy benefit managers.

Friday

Happy birthday to Rep. Ashley Gantt.

9 a.m. — The House is in Session.

Monday

9:30 a.m. — House Appropriations Committee meets. Room 212, Knott Building.

9:30 a.m. — The House Ways & Means Committee meets. Room 17, House Office Building.

2 p.m. — The House Health & Human Services Committee meets. Room 17, House Office Building.

Tuesday

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

10 a.m. — The House is in session.

2 p.m. — AHCA hosts a meeting to obtain public input on the Medicaid 1115 Family Planning Waiver renewal. 2727 Mahan Drive, Building 3, Tallahassee.

4 p.m. — The Senate is in Session.

Wednesday

Happy birthday to Sen. Colleen Burton.

Safety Net Hospital Alliance of Florida Hospital Days at the Capitol.

1:30 p.m. — The House is in Session.

3:30 p.m. — The Senate is in Session.

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