Diagnosis for 5.17.23: 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.

— Still more to come —

As anticipation ramps up ahead of Florida Gov. Ron DeSantis’ expected entry into the presidential race there is an expectation that he will act on outstanding issues from the 2023 Legislative Session before he pivots fully to a national campaign.

Right now, there is speculation that DeSantis could join former President Donald Trump and other candidates later this month or early June.

That means time is ticking. Top of the list for the Governor to act on is the new $117 billion state budget and the billions of health care spending included in the spending plan that takes effect July 1.

But this week DeSantis was also sent several health-care-related bills he must act on by the end of the month including measures on public lactation spaces, the use of telehealth by genetic counselors, a bill that allows school districts to offer menstrual hygiene products and a measure that creates a compact that allows the recognition of psychologist licenses.

Several other high profile health care measures — including one that expands the eligibility for the Florida KidCare program — have not yet been sent to the Governor.

There is no statutory deadline for when bills must be handed over to DeSantis, but usually, the two chambers work in concert with the Governor’s office and deliver legislation when he is prepared to act on it.

So far this year, DeSantis has moved quickly once they are presented to his office.

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— Mental health gets its champions —

May is mental health month and a recent Forbes Adviser study ranked Florida as one of the worst states in the nation for mental health.

But Florida Behavioral Health Association President and CEO Melanie Brown-Woofter told Florida Politics things are looking up. She attributes the outlook to a commitment from the Governor’s Office as well as the emergence of legislators who are willing to champion the issues.

She acknowledges that, historically, mental health and substance abuse services have not gotten the attention or the funding they needed.

“Historically, the stigma around mental illness has been enormous. And there has been a hesitancy in the general population just among family members to talk about it. Even at the dinner table,” Brown-Woofter said. “There have not been conversations about your aunt that might have a problem or your cousin that had this problem. It’s all been hush-hush. As you know legislatively as well, there has just been a fear and a stigma, and there has not been a champion to make that long-term investment in these services.”

The result, she said, was programs were funded with non-recurring dollars which meant providers would have to lobby annually to ensure lawmakers continued funding the programs. Requests for increases in rates for providing the services weren’t made or were ignored.

“But over the last few years, especially under the leadership of Gov. DeSantis and First Lady Casey DeSantis, we have broken that stigma. And we are elevating the need for mental health services and increasing awareness at a record level. And so that has really contributed to the last few years, the willingness of the Legislature to make that investment and for the Governor to sign the budget and to support that as well.”

She also was quick to note that Rep. Sam Garrison, Chair of the House’s health care spending panel and his Senate counterpart, Sen. Gayle Harrell have been “true champions.”

The attention has paid off. Lawmakers included pay raises this year, the first in more than 20 years, which she said were sorely needed.

“With the increase in awareness, you know, the breaking of the stigma, we’re seeing more people present for care. We’re seeing an increase in anxiety disorders, depression in the population, we’re seeing an increase in suicide, obviously, an increase in overdoses and opioid use as well as alcohol use. The demand for services is great. But at the same time, we’re seeing challenges with the workforce, just like in every other segment of the population. So, this rate increase comes at a critical time,” she said.

But it’s not just the recent increases in funding for services and pay rates that have her excited. The Agency for Health Care Administration released its invitation to negotiate the state’s Medicaid Managed Care Program.

“The ITN is incredible; it certainly has a strong focus on behavioral health,” she said, noting that the ITN includes network adequacy requirements for behavioral health providers. She said the ITN requires managed care plans to “really demonstrate that they are contracting for programs and in ways that really increase access, and that are going to work to move the needle on outcomes.”

Value-based purchasing arrangements included in the Medicaid managed care TN put the focus on outcomes not services provided.

“There’s an opportunity here for coordination. That hasn’t existed before now. So, the opportunities are endless. And we were very, very pleased to see the inclusion of behavioral health in the ITN.”

— R-S-T-L-N-E —

The state’s health care industry has warned that Florida will be 10s of thousands of nurses short come 2035 and on-the-ground data shows facilities are already struggling to fill holes in the workforce.

A report published by IHS Markit in 2021 showed that Florida will face a shortfall of 59,100 nurses by 2035 and, specifically, there will be a 12% shortfall in registered nurses (RNs) and a 30% shortfall in licensed practical nurses (LPNs). Already, RNs are the single most desired professional in the state — not just the health care industry.

“Last month, there were roughly 460,000 open jobs in the state of Florida. And among those, I’d say that there were around 65,000 open jobs in the health care industry, led primarily by registered nurses, which are the No. 1 open job in the state of Florida,” Florida Chamber Foundation Director of Research David Sobush said during a panel discussion hosted by MolinaCares.

Data shows RNs are one of many classes of health care professionals that providers are struggling to find. According to the most recent data from the Department of Economic Opportunity, there are also 6,300 job openings for managerial health care jobs and a combined 4,000 openings for LPNs and LVNs.

Sobush said that’s likely an undercount since many job listings aim to fill multiple positions. Further, health care professionals account for 11 of the top 20 most sought-after professionals in STEM-related fields.

“It’s like R-S-T-L-N-E on the Wheel of Fortune,” he said.

The Legislature this year directed $80 million in state funding to nursing programs in the hopes of boosting the state’s nursing education pipeline, including $40 million for the College of Nursing at the University of South Florida.

But USF Nurse Anesthesiology Program Assistant Dean Dr. Michelle Canale said keeping graduates — especially those with higher-level nursing degrees — in Florida presents another challenge.

Sen. Jay Collins, who also participated in the event, said he hopes to address the issue, at least in part, next Legislative Session through a modified version of the occupational licensing reciprocity legislation he sponsored this year. The bill would have allowed people who move to Florida to obtain an occupational license in their new state if they have held the same license in their state for at least one year and met a handful of other requirements.

— High water mark —

Florida’s Medicaid “unwinding” hasn’t started yet according to the most recent data from the Agency for Health Care Administration.

A record high of 5.77 million Floridians were enrolled in Medicaid as of the end of April, according to the monthly report posted by the agency responsible for running the safety net health care program.

Florida’s Medicaid enrollment ballooned over the last three years during the COVID-19 pandemic as federal authorities required states to keep people on the rolls in exchange for getting a higher reimbursement rate from the federal government during the public health emergency.

Congress, however, passed a law in December that called for phasing out the higher reimbursement rates and allowed states to begin removing people who were no longer eligible for coverage — a process that has been called “unwinding.”

State officials previously said they anticipated starting to remove people from Medicaid rolls as soon as April 1. Some advocates have been fearful that hundreds of thousands of people in Florida would soon lose health care coverage once the process kicks in.

But AHCA data shows that Medicaid enrollment has continued to climb. There were 5.63 million enrolled in December compared to 5.77 million at the end of April. The total rose 0.48% from March to April.

The latest figures could suggest that 5.77 million will wind up being the high-water mark for Florida Medicaid as the state begins to look more closely at whether residents remain eligible for coverage.

— 2023 County Health Rankings —

A report issued this spring has a snapshot of health rankings for Florida and its 67 counties as well as the rest of the nation.

Collier County was ranked as the county with the best health outcomes, a category that captures how long people will live in a community, and how much physical and mental health people “experience” while living there.

Conversely, Union County is ranked dead last in the best health outcomes category according to the state according to the County Health Rankings & Roadmaps which is a program of the University of Wisconsin Population Health Institute (UWPHI) with support from the Robert Wood Johnson Foundation.

For the first time, the analysis includes a focus on the connection between civic health and thriving people and places. In measuring civic health researchers reviewed what they called civic infrastructure — which includes the spaces such as schools, parks and libraries that help people stay connected and policies and practices that foster belonging, making civic participation possible — and civic participation, which examines ways people engage in community life to improve conditions and shape the community’s future, whether through voting and advocacy, or community activities such as volunteering and mentoring.

“Our civic health must be nurtured. Intentional investments in civic spaces that foster inclusive participation can have a positive impact on health equity. On the other hand, neglect or deliberate exclusion is detrimental to civic health and our opportunity to thrive,” the authors noted. “Our civic health depends on the decisions we make — whether we are an elected official or a local volunteer — to cultivate community conditions where everyone is welcome, lives with dignity and thrives.

Check out the report here.

— RULES —

— The Board of Pharmacy proposes amending Rule 64B16-27.797 regarding the standards of practice for compounding sterile products. The review will include, but not be limited to, specifically reviewing the need to address and incorporate updated chapters of the United States Pharmacopeia and reviewing the standards related to outsourcing facilities. More here.

—The Board of Dentistry announced changes to proposed amendments to Rule 64B5-12.013 to make changes in response to written comments submitted by the staff of the Joint Administrative Procedures Committee. More here.

—The Board of Pharmacy proposes Rule 64B16-27.650 regarding additional immunizations or vaccines which may be administered by pharmacists. More here.

— LOBBYISTS —

Jeff Aaron, GrayRobinson: Shands HealthCare

James Daughton, Doug Bell, Leslie Dughi, Allison Liby-Schoonover, Aimee Diaz Lyon, Andrew Palmer, Karl Rasmussen, Metz Husband & Daughton: Karuna Therapeutics

Robert Hosay, Foley & Lardner: iLab

Bobby Joe Lolley Jr.: Home Care Association of Florida

Ron Pierce, Melody Arnold, Kaitlyn Bailey, Edward Briggs, Matthew Herndon, Natalie King, RSA Consulting Group: Brevard Health Alliance

Margaret Timmins, Timmins Consulting: Professionals Resource Network

Carlos Trujillo, Continental Strategy: Shands HealthCare

— ETC —

— The end of the public health emergency means private health plans will no longer be required to cover COVID-19 tests ordered or administered by a clinician with no out-of-pocket charge. While some still may continue to do so there is no mandate. The Peterson Center on Healthcare and Kaiser Family Foundation analyzed the cost of COVID-19 testing for people who are insured through a large group plan and the cost of tests for self-pay patients at hospitals that disclosed the information. The analysis found that the costs of the test for employer-based coverage on average totaled $45 in 2021. The median discounted hospital-based self-pay rate was $51 for a COVID-19 antigen test and $91 for a PCR test. The recent prices for at-home rapid COVID-19 tests average about $11 per test. More here.

— ROSTER —

— Samir Akach, M.D., has been named vice president and chief medical officer at St. Joseph’s Hospital in Tampa. According to a release, Akach joins St. Joseph’s with more than 15 years of physician leadership experience. He recently held leadership roles at HCA Florida JFK Hospital and HCA Florida JFK North Hospital in Palm Beach County.

— Nish Patel, M.D. was named director of structural heart disease at Baptist Health Miami Cardiac & Vascular Institute. Dr. Patel succeeds Ramon Quesada, M.D., who was named director of interventional & structural cardiac innovations and research.

— Joe Britner was named chief operating officer for HCA Florida Kendall Hospital, a 447-bed facility.

— Jeremy Goodman, M.D., MBA, FACHE, CPE, FACS, has joined Baptist Health in Jacksonville taking a post as the vice president and system quality officer, a newly created post.

— W. Henry Langhorne III, M.D., FACC, was named the medical director of the Cardiopulmonary Rehabilitation program at Baptist Pensacola Heart & Vascular Institute’s AACPR-accredited cardiac program.

— ICYMI —

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

— Pearly whites: Florida Medicaid officials released a request for information seeking input from potential vendors as it prepares to put its Medicaid Prepaid Dental Program out to bid. Responses to the four-page RFI are due by 5 p.m. May 30. The agency must start the procurement process this year for the six-year dental contracts, which will take effect sometime in 2024. The document solicits information on innovative ideas and best practices to improve Florida’s dental care services for Medicaid beneficiaries. There is an emphasis on ways to improve dental care services for people with intellectual and developmental disabilities enrolled in the Medicaid waiver program called iBudget.

— No comment: DeSantis is offering a solution to the current federal debt ceiling crisis. “What they should be doing is reducing spending,” DeSantis said in Miami. “I think the idea that you would just raise (the debt ceiling) without anything is ridiculous. And we were $21 trillion in debt like five years ago and now we’re $31 trillion in debt. And I think Joe Biden’s position is you just keep spending like no end and eventually it’s going to solve itself.” However, the Governor ignored the question from a reporter about whether Social Security and Medicare should be “on the table,” instead offering a 50,000-foot view of federal spending beyond its means.

— No thanks: The Biden administration is making Medicaid available for nearly 580,000 people who came to the United States as children but can’t otherwise qualify for Medicaid because of their immigration status. But Florida won’t be taking advantage of the option that was announced in April. In fact, DeSantis’ administration is doubling down on its opposition. DeSantis made clear at a Jacksonville news conference that he has no intention of tapping into the program. He made the comments after he signed SB 1718, a sweeping immigration bill that essentially bans Florida counties from issuing identification cards or other documents to individuals who do not provide proof of lawful presence in the United States.

— Ring ring: Telephones are now an allowable technology for telehealth in Florida. DeSantis signed Thursday night, along with more than 30 other bills he received earlier this week. Sponsored by Rep. Tom Fabricio, the bill passed the Legislature unanimously. After wrangling over the issue for years, the Florida Legislature in 2019 passed a telehealth law that set the standards of care for telehealth. The law clarified that the telehealth platform could not use audio-only calls, facsimiles and emails.

— Big boost: Florida has a nursing crisis and lawmakers continue to look to the University of South Florida College of Nursing to help abate it. The USF College of Nursing received more than $40 million in the fiscal year 2023-24 budget lawmakers passed this Session to help increase the number of registered nurses in the workforce. USF College of Nursing Assistant Dean Michelle Canale said the money was appropriated based on the College of Nursing’s “performance and merit.”

— FOR YOUR RADAR —

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

—“Joseph Ladapo says anti-vaccine crusade was God’s plan. It cost him his peers’ trust” via Cindy Krischer Goodman and Catherine Catherman of the Orlando Sentinel — Florida Surgeon General Ladapo asserted the mRNA COVID-19 vaccine “has a terrible safety profile.” “At this point in the pandemic, I’m not sure anyone should be taking them,” he said. This type of COVID rhetoric had helped the former University of California-Los Angeles associate professor catch the eye of the Florida Governor with big political ambitions. His evolution placed him in a position of power that peers say came at the cost of the respect of many in the academic and medical communities.

—“What to expect under Florida’s immigration bill? Uncertainty.” via Juan Carlos Chavez of the Tampa Bay Times — DeSantis signed the new immigration law. It expands the requirements for businesses with 25 or more employees to use E-Verify, a registration system run by the U.S. Department of Homeland Security that checks the immigration status of workers. The new measure also requires hospitals that accept Medicaid to ask about patients’ immigration status during the admissions process and imposes penalties against individuals who transport someone without legal status into the state, which can result in a third-degree felony.

—“DeSantis can’t quit COVID-19” via Arek Sarkissian of POLITICO — America is moving on from COVID-19. DeSantis can’t stop talking about it. With the COVID-19-triggered national health emergency expiring, DeSantis has been crisscrossing the country touting his handling of the virus. DeSantis criticized “lockdown politicians” during a visit to California and called Florida a “refuge of sanity” amid pandemic closures when he was in South Carolina last month. At Liberty University in Virginia two weeks ago, the Governor said he bucked the political and medical establishment to keep Florida open. DeSantis, who is expected to announce a presidential bid in the coming weeks, has gone even further in his home state.

—“Robert F. Kennedy Jr.: DeSantis invited me to breakfast, said he wanted to burn the NIH ‘to the ground’” via David Weigel and Shelby Talcott of Semafor — DeSantis told vaccine skeptic Kennedy that he wanted to “burn” the National Institutes of Health “to the ground.” In a May 9 conversation with actor Russell Brand, Kennedy said that DeSantis invited him to breakfast during the COVID-19 pandemic, to discuss what Kennedy described as his “science-based response” to the crisis. “We talked about him possibly running for the presidency, and I said, how will you handle the NIH?” Kennedy told Brand, whose talk show has more than 1.1 million subscribers on the YouTube alternative Rumble. “And he said: ‘I’ll burn it to the ground.’ You know, I understand the impulse. But I think I can have a more surgical impact on these agencies.”

—“Were Medical Examiner’s complaints politically motivated? Not so, funeral directors say.” via Mollye Barrows of the Pensacola News Journal — Letters recently sent to Escambia County Commissioners complaining about the Medical Examiner’s Office treatment of bodies were never meant to be made public, said two of the three funeral directors who wrote them. They also said they wrote the letters after meeting with Escambia County Commissioner Steven Barry, who encouraged the funeral directors to write them. Their issues included the condition of bodies after autopsy being “butchered,” unclean and placed in bags that leak, as well as delays with filing paperwork or listing misleading or inaccurate causes of death. Accusations the Medical Examiner’s Office said were largely “not substantiated.”

— PENCIL IT IN —

Friday

Happy birthday to Senate President Kathleen Passidomo.

Saturday

Happy birthday to Sen. Jason Pizzo and Rep. Anna Eskamani.

Monday

9:30 a.m. — The Public Health Integrity Committee meets. Location: Cabinet Room.

Tuesday

Happy birthday to Sen. Ana Maria Rodriguez.

9 a.m. — The Governor and Cabinet meet. Place: Cabinet Meeting Room. Agenda here.

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