Diagnosis for 4.26.23: Checking the pulse of Florida health care news and policy

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It's time again to check the pulse — of Florida's health care policy and politics.

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

— Medicaid ITN Surprise —

With the hectic pace of the 2023 Legislative Session, it’s easy to forget that the Agency for Health Care Administration released an invitation to negotiate (ITN) for its Statewide Medicaid Managed Care Program.

But the deadline for health care providers to submit any questions about the massive ITN is May 3, two days before Session is scheduled to end.

Expect questions about a provision in the ITN that would place Medicaid iBudget waiver enrollees as well as those on the waiting list for waiver services into managed medical assistance plans.

The ITN contains a section called “Passive Enrollment of Voluntary Recipients with Opt Out.”

In addition to impacting Medicaid beneficiaries who have developmental disabilities or intellectual disabilities, the passive enrollment also will apply to children served by prescribed pediatric extended care centers as well as Medicaid recipients with “other creditable health care coverage, excluding Medicare.”

“Certain Medicaid recipients are exempt from mandatory managed care enrollment and may voluntarily choose to participate in the MMA program,” the ITN reads. “With the transition enrollment, (they) will be assigned to a managed care plan and provided the opportunity to opt-out.”

It’s not clear whether iBudget enrollees and others impacted by the change will, like all other Medicaid enrollees in the managed care program, be given an opportunity to voluntarily choose a plan or just be assigned to one by the state.

The ITN also does not spell out any details about the opt-out or if they would be assigned to another managed care plan or defer the fee for service care.

The change — tucked deep in the ITN — took managed care plans by surprise, lobbyists told Florida Politics.

The change also comes as lawmakers consider legislation this Session that would create a managed care pilot project to test how to integrate the delivery of home and community-based services under the iBudget waiver and medical services under one provider who is paid to manage both. Those bills (HB 831/SB 1084) have moved through the process.

APD administers the Medicaid iBudget waiver program. More than 35,000 people with developmental and or intellectual disabilities are enrolled in the waiver program that allows them to receive home and community-based services.

Currently, the waitlist includes 22,535 people. More than 9,000 of them are eligible for and receive Medicaid coverage for medical care. Because they aren’t required to enroll in managed care plans, they can receive their health care from providers of their choice. Those providers are reimbursed on a fee-for-service basis.

While the plans must submit their questions by next week, AHCA has time to prepare responses. According to the ITN, AHCA anticipates having its responses complete by June 27. Responses to the ITN must be submitted by noon, Aug. 15.

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— More MMJ licenses —

Also, don’t forget about medical marijuana licenses.

The state started accepting applications for medical marijuana licenses April 24 and will continue to do so through 5 p.m. April 28. Along with the applications, vendors must submit a non-refundable $146,000 application fee.

Gov. Ron DeSantis’ administration announced 22 medical marijuana licenses will be available. The state in December published guidelines for new licenses via emergency rule. In February, it published another emergency rule announcing the window for applications.

*Ron DeSantis says there are marijuana licenses up for grabs.*

Florida Politics asked DOH how many applications it had received early Wednesday morning. DOH did not respond to the inquiry by press time.

The state is projecting 1,044,072 patients will qualify for medical marijuana treatment and register with the state by June 2024.

— DACA care —

Federal authorities said this week they are pushing ahead with a plan that would expand access to health care programs to tens of thousands of undocumented young people who are Deferred Action for Childhood Arrivals (DACA) recipients, often referred to as Dreamers.

There are an estimated 580,000 DACA recipients in the country, including about 23,000 in Florida.

The U.S. Department of Health and Human Services announced it was going to put in place new rules that would open up certain programs run by the Centers for Medicare & Medicaid Services to Dreamers, including health insurance marketplaces and some Medicaid and children’s health insurance programs.

*New rules are opening access to health care for Dreamers.*

“Young people who come to this country — in many cases, the only country they have ever known as home — work hard to build their lives here, and they should be able to keep themselves healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The Biden-Harris Administration is committed to ensuring affordable, quality health care for all, and to providing DACA recipients the opportunities and support they need to succeed.”

The proposal would end current exclusions that treat DACA recipients differently and could lead to as many as 129,000 previously uninsured recipients receiving coverage.

It would open Medicaid and children’s health insurance coverage to children and pregnant women, and it would make DACA recipients eligible for financial assistance through the health insurance marketplace.

If the rule is finalized as proposed, there would be a 60-day special enrollment period for DACA recipients to select a qualified health plan through a marketplace.

— What’s it all about? —

The tussle over pharmacy benefit managers and narrow networks took an interesting turn this week when the House agreed to tag an amendment onto its PBM bill (HB 1509).

The bills were all but identical heading into the House Health and Human Services Committee’s meeting, but the amendment guarantees the chambers will have to “bounce” the bill — a DeSantis priority — between the chambers at least once before final passage.

Perhaps more interesting, though, are the remarks made by the pharmacy benefit management and insurance industry in support of the amendment.

“We believe that many of the cost drivers in the original bill are being addressed by this amendment,” Florida Association of Health Plans President and CEO Audrey Brown told members.

*Linda Chaney downplays the costs of a PBM amendment.*

PCMA senior director of state affairs Connor Rose called the amendment a “move in the right direction to avoid unintended costs.”

A staff analysis indicates that the costs could be significant, but bill sponsor Rep. Linda Chaney downplayed the estimates.

But Chaney said the amendment had been worked on in advance with the Governor’s office and the Florida Senate.

— DeSantis’ other priorities —

Regulating PBMs isn’t the Governor’s only health care priority this Session. Legislators have moved bills to ensure that Florida-specific laws regarding COVID-19 vaccines and masks don’t expire June 1.

Sen. Colleen Burton has sponsored legislation (SB 252) that keeps intact the law that prohibits businesses, governmental entities, and educational institutions from requiring a person to wear a face mask, face shield or any other facial covering that covers the mouth and nose. It also prohibits such entities and institutions from denying a person access to, entry upon, service from, or admission to, or otherwise discriminating against someone based on their refusal to wear a mask.

*Colleen Burton says you don’t have to mask up anymore, and no one can tell you to do so.*

Health care providers are exempt from that provision. Instead, the bill requires AHCA and the Florida Department of Health by July 1 to develop standards for the appropriate use of facial coverings for infection control in health care settings. Guided by those rules, health care providers and practitioners would have until Aug. 1 to set mask policies.

SB 252 also creates a new section of law to prohibit hospitals from interfering with a patient’s right to choose COVID-19 treatment alternatives as recommended by a health care practitioner with privileges at the hospital as long as the practitioner has the informed consent of the patient. A hospital that violates this provision is subject to AHCA disciplinary action.

SB 252 is on the Senate Calendar. Its companion (HB 103) is on the House calendar.

Another DeSantis priority is to establish in law rights of conscience for health care providers and payers to object to rendering or reimbursing for services they object to providing or paying for.

The proposals (HB 1403 and SB 1580) have cleared all their committees of reference and are awaiting action in their respective chambers.

— RULES —

The Florida Department of Health proposes amending Rule 64K-1.002 to include American Society for Automation in Pharmacy (ASAP) standards for practitioners and pharmacies reporting controlled substance dispensing. More here.

— LOBBYISTS —

Todd Lewis, Lewis Consulting: Florida Healthy Alternatives Association

Frank Mayernick, Tracy Mayernick, The Mayernick Group: CDS Family & Behavioral Health Services

Jonathan Weiss: Insightec

— ETC —

—Florida Blue ranks as one of the nation’s best health insurance companies in 2023 according to Insure.com. The annual ranking is based on a compilation of insurer survey results, National Committee of Quality Assurance ratings and customer complaints tracked by the National Association of Insurance Commissioners. Five is the highest possible score and Florida Blue earned 2.98 putting it at No. 8 on the list. Kaiser Permanente, which does not operate in Florida, earned a score of 4.16 making it the top-ranked company on the list.

*Florida Blue is among the best in 2023.*

—Centene reported a double-digit profit increase in the first three months of 2023 and added more than 2 million members year over year, according to its first quarter earnings posted April 25. Total revenues in the first quarter were $38.9 billion, up 4.6% year-over-year. The company’s medical loss ratio was 87.0%. In the first quarter and 87.3% during the same period last year.

— ROSTER —

Corey Lovelace has been named CEO of HCA Florida St. Lucie Hospital, a 207-bed acute care facility located in Port St. Lucie. Lovelace was previously the COO of HCA Florida Kendall Hospital, a 447-bed facility with two free-standing emergency rooms.

*Congrats to Corey Lovelace, the new CEO of HCA Florida St. Lucie Hospital.*

Seven Florida hospital executives were named to Becker’s Community Hospital CEO’s “Get to Know List.” They are James Machado, regional president, Ascension St. Vincent’s Southside and Ascension St. Vincent’s; Thibaut van Marck, senior vice president, Orlando Health Southeast Region and president, Orlando Health Dr. P. Phillips Hospital; Cheryl McIntire, CEO and CFO of Lehigh Regional Medical Prime Healthcare; George Mikitarian, president and CEO of Parrish Medical Center; Shawn Molsberger, senior vice president of Orlando Health Northeast Region and president of Orlando Health South Seminole Hospital; Lance Sewell, senior vice president of Orlando Health North Central Region and President of Orlando Health South Lake Hospital; and Jared Smith, CEO of Baptist Health Bethesda Hospital East and Bethesda Hospital.

AHCA hired Stefan Grow to serve as Chief of Staff to Secretary Jason Weida, the agency told the Florida Standard. Additionally, Brock Juarez, who had been serving as the acting Chief of Staff, has been named assistant deputy secretary of health care transparency and provider outreach. Kristin Sokolowski was named deputy Chief of Staff of Medicaid and procurement and Sketch Piers was named director of external affairs and provider outreach. Grow is the only new hire.

— ICYMI —

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

— More money, no problems: A top priority of DeSantis cleared its last House committee and is ready for the chamber floor. Despite concerns HB 1509 could increase health insurance costs in the commercial market, state group health plans and Medicaid, the committee unanimously approved the bill, which has broad support from hospitals, pharmacists and community pharmacies.

— Moving on through: DeSantis’ picks for his health and human services agencies cleared their final committee stop Monday, with State Surgeon General Joseph Ladapo facing nearly an hour of intense back-and-forth questioning from skeptical Democrats. The final vote was 6-3 to recommend Ladapo with all three Democrats on the Senate Ethics and Elections Committee voting in opposition. The committee also voted to recommend confirmation for Agency for Health Care Administration Secretary Jason Weida, Agency for Persons with Disabilities Director Taylor Hatch, Department of Elder Affairs Secretary Michelle Branham and Department of Children and Families Secretary Shevaun Harris. The full Senate is expected to vote for confirmation before the Legislative Session ends.

— Bad news: The House is poised to ratchet up the battle over gender-affirming care by taking the highly unusual step of issuing subpoenas to two professional groups that support such treatments despite ongoing efforts by Florida officials to ban the practice for minors. The House Health and Human Services Committee voted along party lines to ask House Speaker Paul Renner to subpoena the Florida Chapter of the American Academy of Pediatrics (FCAAP) and the Florida Psychiatric Society.

*Lawmakers urge Paul Renner to send subpoenas to a pair of gender-affirming care supporters.*

— Good news: With a $15 billion general revenue appropriation and the state flush in money, those days appear to be a thing of the past — at least for the Fiscal Year 2023-24 budget. The 2023-24 health and human services budget being hammered out by conferees this week has more than $323 million in proposed rate increases for 12 different types of health care providers, including those that deliver durable medical equipment, Medicaid beneficiaries, pediatricians, community mental health providers and nursing homes.

— New purpose in life: Nearly two years after both her sons were killed by her estranged husband, a surviving mother is picking up the pieces of her life to move forward as untold storylines about the murders are just emerging. Minde O’Sullivan, 44, of Gainesville said her new marriage to the University of Florida baseball coach, Kevin O’Sullivan, and a nonprofit foundation she created in honor of her boys, Rex Reinhart, 14, and Brody Reinhart, 11, have given her a new purpose in life.

— FOR YOUR RADAR —

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

—“A closer look at the U.S. pandemic response reached an unsettling conclusion” via The Washington Post editorial board — The United States, once the paragon of can-do pragmatism, of successful moon shots and biomedical breakthroughs, fell down on the job in confronting the crisis. The pandemic, the experts say, revealed “a collective national incompetence in government.” This warning comes through over and over again in “Lessons from the COVID War: An Investigative Report.” The United States started out “with more capabilities than any other country in the world,” they note. But it ended up with 1 million dead. “The COVID war is a story of how our wondrous scientific knowledge has run far, far ahead of the organized human ability to apply that knowledge in practice.”

—“Hurricane Ian recovery efforts still underway, Lee Health clinic reopens in Dunbar” via Erica Van Buren of the Fort Myers News-Press — About 50 Lee Health staff, residents and city officials gathered to celebrate the opening of the new Lee Community Healthcare’s Dunbar medical office. The Dunbar clinic, located at 3637 Dr. Martin Luther King Jr. Blvd. in the plaza with Next Level Church, will offer primary health care including family medicine as well as behavioral and mental health services for both children and adults. The medical office, which opens its doors to seeing patients Tuesday at 7 a.m., will be made up of three doctors, one nurse practitioner, and one psychologist, with a total of about 25 staff members in all.

*As hurricane recovery continues, Lee Health opens a new Lee Community Healthcare Dunbar medical office.*

—“Paul Renner launches House Committee investigation into ‘gender-affirming care’ standard” via Lydia Nusbaum of Florida’s Voice — Renner authorized a House Committee to investigate whether there was rigorous medical consideration in the endorsement of “gender-affirming care” standards for minors. The move comes as Florida Republicans are passing legislation to ban certain gender dysphoria treatments including sex reassignment surgeries and medications for minors. In a letter to Rep. Randy Fine, who chairs the Health and Human Services Committee, Renner said the Committee is allowed to investigate “whether the integrity of the medical profession has been compromised by a radical gender ideology that stands to cause permanent physical and mental harm to children and adolescents.”

—“Florida wants to bar schools from talking about menstruation. What would Judy Blume say?” via Jennifer Weiss-Wolf of The Los Angeles Times — The film “Are You There God? It’s Me, Margaret,” an adaptation of Blume’s iconic 1970 book about preteen firsts. A new bill preventing discussion of periods wouldn’t just censor health teachers. It would have broad and probably unintended effects across many facets of education, such as literature, history and civics. Even Anne Frank’s “The Diary of a Young Girl” could be barred solely for its references to menstruation. Blume herself initially weighed in with a simple tweet: “Sorry, Margaret.” She later issued a full-throated rebuke of the politics behind the proposal, wishing Florida lawmakers “good luck” in their attempts to police girls in elementary school.

—“Agency for Health Care Administration announces leadership shake-up” via Caden DeLisa of The Capitolist — The state Agency for Health Care Administration (AHCA) announced a series of changes in leadership positions Friday evening, as confirmed by the organization. The agency’s leadership team beginning Monday will be comprised of Stefan Grow as incoming Chief of Staff, Brock Juarez as the Assistant Deputy Secretary of Health Care Transparency and Provider Outreach, Kristin Sokolowski as the Deputy Chief of Staff of Medicaid and Procurement, and Sketch Piers as the Director of External Affairs and Provider Outreach. Last March, Juarez was announced as AHCA’s Communications Director, joining the agency following a stint with the Florida Healthy Kids Association.

—“Arcturus COVID-19 strain invades Florida. And where did the name come from?” via Chris Persaud of The Palm Beach Post — As COVID-19-positive patients continue leaving Florida’s hospitals, the latest viral variant thought to cause pink eye has been spreading in the state. Meanwhile, state health officials have yet to resume weekly reporting of case and death data to the federal CDC. A dozen cases of arcturus, a coronavirus strain that appears to be linked to pink eye infections, have been found in Florida so far.

—”Funeral homes complain to Escambia County bodies are being ‘butchered’ in autopsy” via Mollye Barrows of the Pensacola News Journal — The owners and directors of several Pensacola funeral homes sent letters to Escambia County expressing their concerns about the District One Medical Examiner’s Office, including the condition of bodies when they leave the office after autopsy. Their allegations include that bodies are being transported in torn bags that leak, that trash is in the bags as well as body cavities, and that remains aren’t as clean as they could be, among other issues. “First and foremost, the autopsies performed in this office I would almost equate with mutilation,” wrote Pensacola Memorial Gardens funeral director Jerald Mitchell.

— PENCIL IT IN —

Thursday

Happy birthday to Rep. Adam Botana.