Diagnosis for 6.7.23: 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.

— Dubious distinction —

Florida is leading the country in the number of people disenrolled in Medicaid, according to a recent comparison of state-by-state figures assembled by the Kaiser Family Foundation, although that number will soon be updated.

States were not allowed to disenroll people from the safety net health care program during the bulk of the public health emergency connected to COVID-19. That changed this spring and states such as Florida have begun reviewing the rolls to see if people are no longer eligible for coverage.

The foundation reported that nearly 600,000 people nationally had been removed from the Medicaid rolls so far. Nearly 250,000 were Floridians.

That was far and away the largest number reported by any state. Arkansas was second with nearly 73,000 people disenrolled followed by Indiana with 53,000 people removed from Medicaid.

Those numbers will be revised soon since states are required to give updates to the Centers for Medicare and Medicaid Services on the eighth of every month. The Florida Department of Children and Families (DCF) has previously said that the numbers given to the federal government are a snapshot at that time and noted that individuals have 90 days to submit information for a redetermination of their Medicaid eligibility.

DCF said that in April and May it had sent nearly 2 million text messages and more than 1.2 million emails to those enrollees whose coverage was up for renewal.

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— Poison amendment? —

Will a move to increase the number of medical marijuana licenses awarded to Black farmers poison a telehealth bill?

Among the bills yet to be sent to Gov. Ron DeSantis is HB 387, which allows medical marijuana users to renew physician certifications through telehealth, something the Governor allowed through executive order during the COVID-19 pandemic and his administration authorized after Hurricane Ian disrupted access to physicians.

But some are privately worrying that a last-minute Senate amendment tagged onto the bill meant to address ongoing litigation with Black farmers could put the bill in jeopardy of DeSantis veto.

The question is whether the Republican Governor now running for President will support a remedy that is rooted in previous lawsuits and federal actions designed to pay Black farmers who said they were discriminated against by the federal government.

Under current law, the Florida Department of Health must issue a single license to a class member of the Pigford class, a reference to a 1999 settlement with the U.S. Department of Agriculture. The state granted the license to a Black farmer and Pigford class member Terry Gwynn last September. But It denied 11 other applicants which has resulted in a round of lawsuits.

The Senate used HB 387 to address the ongoing litigation by putting in new stipulations on which applicants could receive a license. A bill analysis maintains that the changes could result in a majority, if not all, of the 11 unsuccessful applicants being awarded a valuable medical marijuana license.

There are 26 licenses currently available, and the licenses awarded under the bill provisions wouldn’t impact that number. Instead, it will reduce the number of licenses available when the patient population reaches 1.1 million.

The Black farmer issue was amended onto the bill during the waning days of Session. While it passed the Senate unanimously and passed the House by an overwhelming bipartisan vote, it was opposed by the likes of Rep. Randy Fine and Tommy Gregory, among others.

Sen. Darryl Rouson, who championed the Black farmer issue, declined to comment for the story.

There was a buzz about a potential veto during the Florida Medical Cannabis Conference and Exhibition that took place last weekend in Orlando.

— Meet the applicants —

Esposito Nursery is a well-known one-stop-shop in Tallahassee where people can shop for everything that’s needed for lush green lawns, gorgeous gardens and landscape services.

It could be expanding its business to include medical marijuana.

Esposito Nursery Inc. was one of 74 entities that submitted a medical marijuana application to the Department of Health Office of Medical Marijuana Use.

Tallahassee physician Mark Moore also applied under the name Capital Cannabis. Moore founded MEDCAN, which according to its website, is the first medical marijuana doctor’s office in the state.

Entities were required to submit a $146,000 nonrefundable fee along with the application. That means the state received $10,804,000 for the April 2023 batching cycle.

While the state has posted the names of the applicants on its website it still has not made available for the public to review copies of the redacted applications.

— More on MMJ —

Under DOH Emergency Rule 64ER23-2, caregivers who are not “close relatives” applying for a caregiver medical marijuana use registry identification card must complete a level 2 background screening.

The law defines a close relative as “a spouse, parent, sibling, grandparent, child or grandchild, whether related by whole or half-blood, by marriage or by adoption.”

Florida law allows certified patients to designate a caregiver to assist them with the purchase and administration of medical marijuana products.

Patients who are minors must designate a caregiver because minors cannot purchase marijuana.

Only the patient’s certifying physician can add a caregiver’s name to a patient’s profile in the marijuana use registry.

According to the Office of Medical Marijuana Use, current caregivers will be grandfathered in until the time of their next renewal.

As of June 2, there were 822,818 patients in Florida who were qualified to use medical marijuana and 2,480 qualified physicians who could certify patients for medical marijuana. There were 571 approved dispensing stations.

— Emergency trans-care rules —

The Board of Medicine (BOM) adopted an emergency rule Friday that allows transgender minors who have been treated with puberty blockers and transgender adults who are taking hormones to continue taking their current medication for an additional six months.

The emergency rule gives the BOM six months to create the informed consent forms required under a new law (SB 254) and to formally adopt them through the rule-making process.

The Board of Osteopathic Medicine (BOOM), a sister board to the BOM, is expected to follow suit.

The emergency rule applies to minors who were being treated with puberty blockers and hormones before May 18 when DeSantis signed SB 254 into law. Most transgender minors who weren’t in treatment before that date are banned from receiving care under the new law.

Federal Judge Robert Hinkle issued an order this week giving the green light for three minors who weren’t in treatment before May 18 to receive the care. The minors were plaintiffs in a lawsuit challenging SB 254 and BOM and BOOM rules banning the care for minors.

— RULES —

The Board of Nursing changed its proposed amendments to Rules 64B9-12.003; 64B9-12.004; 64B9-12.005 regarding intravenous therapy by licensed nurses. More here.

The Board of Nursing proposes amending Rule 64B9-3.002 to clarify language regarding test scores. More here.

The Board of Nursing proposes amending Rule 64B9-8.006 to update penalties. More here.

The Board of Acupuncture proposes amending Rule 64B1-3.010 to clarify existing requirements for licensure. More here.

The Board of Acupuncture proposes amending Rule 64B1-4.010 to clarify existing requirements for acupuncture programs. More here.

The Board of Pharmacy is developing amendments to Rule 64B16-27.650 regarding additional immunizations or vaccines which may be administered. More here.

The Board of Pharmacy proposes amending Rule 64B16-28.108 regarding dispensing medication to a blind or visually impaired patient. More here.

— LOBBYISTS —

Heathcliff Beach: Quelliv

Anna Higgins, Victoria Zepp, Team 180 Consulting: One Hope United

Doug Holder, The Legis Group: Virtus Health

Jeff Johnston, Amanda Stewart, Anita Berry, Johnston & Stewart Government Strategies: Agency for Community Treatment Services

Matt Spritz: Unicorn Children’s Foundation

Christa Stevens: Autism Speaks

Margaret Timmins, Timmins Consulting: More Transplants More Life

— ETC —

— The Florida Office of Insurance Regulation (OIR) continues to look for a new Deputy Life and Health Commissioner, staff told Florid Politics this week. “The OIR maintains a commitment to recruit and retain talent to fill all positions,” Samantha Bequer said. Florida Insurance Commissioner Michael Yaworsky announced Sheryl Parker was named Deputy Commissioner of Market Regulation, a newly created position, and Virginia Christy as OIR’s Deputy Commissioner of Property and Casualty.

— UnitedHealth Group (UNH) issued a news release Wednesday announcing an increase in its dividend and provided an update on its 2023 annual shareholder meeting. The release notes that the Board of Directors authorized a 14% increase in its quarterly cash dividend. A cash dividend of $1.88 per share, will be paid on June 27, 2023, to all shareholders of record of UNH common stock as of the close of business June 19, 2023. This dividend represents an increase over the quarterly dividend of $1.65 per share the company has paid since the second quarter of 2022. According to the release shareholders voted against shareholder proposals to conduct a third-party racial equity audit, prepare a political contributions congruency report, and require shareholder ratification of termination pay.

— Roughly $65 million is being made available for new construction, renovations and infrastructure repairs at Health Research health centers in Florida, North Carolina, South Carolina, and Puerto Rico to prevent flooding, upgrade emergency generators, and improve communication and mechanical systems ahead of future disasters. The U.S. Department of Health and Human Services (HHS) announced the Health Resources and Services Administration (HRSA) announced applicants were due by 5 p.m. July 6. “Last year, HRSA-funded health centers provided essential care to the people impacted by hurricanes Fiona and Ian,” said HHS Secretary Xavier Becerra. “These new funds will make it possible for more individuals and families, especially those most often impacted by disasters and emergencies, to access health centers.” Capital Assistance for Hurricane Response and Recovery Efforts (CARE) funds can be spent on flooding mitigation projects, clinic relocations or upgrades to emergency generators, or communication and mechanical improvements. The CARE Technical Assistance webpage has more details about the funding opportunities. There are roughly 1,400 HRSA-funded health centers nationwide. To locate an HRSA-supported health center, visit https://findahealthcenter.hrsa.gov.

— The University of South Florida received a $2,176,610 award for a suicide prevention and early intervention program. HHS awarded $5.9 million in all. USF was the only entity in Florida to be awarded a grant.

— The Schatzi and Stanley Kassal Project: Newborn Neonatal Intensive Care Unit (NICU) at Holtz Children’s Hospital at the University of Miami/Jackson Memorial Medical Center has been designated a Level IV Neonatal Intensive Care Unit (NIC). It has 26 patient beds. A Level IV designation is the highest level a NICU can achieve.

— ROSTER —

— Bijou Ikli, a veteran executive in the Florida health care and senior living field, has been named the new CEO of the Florida Assisted Living Association. Ikli succeeds Veronica Catoe, FALA’s CEO from 2019-2023, who moved on to become Executive Director at Medicaid Management Services Inc., and interim FALA CEO Shad Haston. Ikli previously served as Director of Facility Relations and Director of Strategic Partnerships at Kindred AtHome; Vice president of Strategic Development at Absolute Elder Care; Vice president of Strategic Initiatives at LHC Group; and most recently, Director of Strategic Partnerships at Growing Bolder, a Florida-based national multimedia platform dedicated to enhancing senior lifestyles.

— Florida Blue announced the addition of three health care executives to its South Florida team. Alvaro “Al” Molina will oversee Miami-Dade & Monroe counties; Jacinda “Cindy” Jackson will be responsible for Broward County; and Juan Awad will oversee Palm Beach, Martin, St Lucie, Okeechobee and Indian River counties (Treasure Coast)

Each market leader will develop, lead and execute a hyperlocal strategy for Florida Blue that includes sales, products, analytics, provider networks, care management, as well as local marketing and community relations.

— Baptist Health Doctors Hospital announced its medical leaders for the 2023-2027 term. Pulmonologist Brenda Gonzalez, M.D., was named president of the medical staff. Orthopedic surgeon Alex Van der Ven, M.D. was named the vice president of the medical staff.
internal medicine physician Bernhard Brijbag, D.O., was named the secretary of the medical staff; orthopedic surgeon Rafael Fernandez, M.D., was named the past-president of the medical staff. Intensivist Douglas Portillo was named Chair of the Department of Medicine and orthopedic surgeon Juan Carlos Suarez was named Chair of the Department of Surgery.

— ICYMI —

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

Stop right there: U.S. District Judge Robert Hinkle’s ruling only applies to three minors whose parents sought an immediate block to Florida’s ban on gender-affirming care, but the action signals that the law itself could eventually get struck down. In his 44-page ruling, Hinkle pushed back on the assertions made by attorneys defending the ban — which was pushed by the DeSantis administration and Surgeon General Joseph Ladapo. In his order, Hinkle took aim at criticisms of the medical organizations in the United States that have endorsed gender-affirming care. “The defendants say, in effect, that the organizations were dominated by individuals who pursued good politics, not good medicine. If ever a pot called a kettle black, it is here,” Hinkle wrote.

Heads up: DeSantis vetoed a priority bill (SB 230) of Senate President Kathleen Passidomo Friday and offered no explanation in his official veto message. The veto of SB 230, which would have prevented optometrists from calling themselves “physicians,” is the latest chapter in the long-running “eyeball wars” saga in the Capitol that has been waged between optometrists and ophthalmologists. Katie Betta, a representative for Passidomo, said the Senate President was made aware the veto was coming and that she believes the bill started an “important conversation she hopes to continue.”

On the hook: Steeper penalties are coming in Florida for people who distribute illegal drugs that result in overdoses. A new law (HB 365) going into effect next month will lower the legal threshold for both capital and felony charges when a person overdoses on an illicit substance. State statutes already provide that a person can be charged with murder if someone dies because of a drug they distributed. But for that charge to stick, the drug in question must be the “proximate cause” of death — a standard difficult to determine when people die with multiple substances in their system. HB 365, which DeSantis signed Monday, lowers that standard.

Reporting for duty: Current and former members of the U.S. Armed Forces with in-the-field medical experience will soon have an easier time transitioning to a related career in Florida. DeSantis signed legislation (SB 274) requiring Florida state universities, colleges and career schools to award nursing credits to American combat medics commensurate with their practical knowledge. The measure, sponsored by Sen. Bryan Ávila, a lieutenant in the Florida Army National Guard, is appropriately titled the “Pathway for Combat Medics Act.” Rep. Joel Rudman carried a House companion of the bill, which received unanimous support in both chambers of the Legislature.

Hands off: People visiting or admitted to hospitals in Florida will soon have even more of a reason — beyond just plain common decency — to keep their hands to themselves. Beginning Oct. 1, 2023, assaulting or battering or hospital workers will result in stiffer charges than doing so to other members of the populace, thanks to legislation DeSantis has now signed. In Florida, assault is a second-degree misdemeanor, while battery typically is punishable as a first-degree misdemeanor. However, punishment for those acts is elevated when committed against people of certain professions, including police, firefighters and emergency medical care providers. The measure (HB 825) DeSantis approved Wednesday adds hospital personnel, including volunteers, to that select group.

— FOR YOUR RADAR —

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

—“Did Duval County jail’s health care contractor lie before signing $98M deal with city? It’s under investigation” via Anne Maxwell of News 4 Jax — Miami-area executives for the embattled health care contractor at the Duval County Jail donated thousands to the campaign of T.K. Waters just days before he was elected Sheriff. The contractor, Armor Correctional Health Services, has been accused of misrepresenting its past criminal convictions and denying a local inmate lifesaving medication that led to his death. Records revealed the Armor executives donated at least $7,000 to Waters’ campaign for Sheriff five days before he was elected in November. Two days before those donations were made, the company signed a lucrative new five-year deal with JSO worth $98 million.

—“UF Health unveils Mobile Stroke Treatment Unit, aims to bring care to stroke victims” via Nora O’Neill of The Gainesville Sun — UF Health unveiled the state’s first Mobile Stroke Treatment Unit in a ribbon-cutting ceremony at the University of Florida on Monday. The unit is equipped to bring stroke treatments to the victim, allowing medical professionals to respond more quickly in life-threatening situations. UF Health President David R. Nelson said that the mobile unit and others to come could help treat and save many of the 40,000 stroke victims UF Health sees.

—“Apple plans iPhone journaling app in expansion of health initiatives” via Aaron Tilley of The Wall Street Journal — Apple is planning an iPhone app to let users compile their daily activities as part of its efforts in the market for mental and physical health technology. The software will compete in a category of so-called journaling apps, such as Day One, which lets users track and record their activities and thoughts. The new Apple product underscores the company’s growing interest in mental health.

—“Sarasota, Manatee counties issue mosquito-borne illness advisory after malaria case reported” via Katlyn Brieskorn of CNBC — Health officials in Manatee and Sarasota counties issued a mosquito-borne illness advisory after a malaria case was reported. The Florida Department of Health in Sarasota County and Manatee County and there has been one confirmed case of malaria. The patient had spent extensive time outdoors and was treated at a hospital. The case has been identified as the P. vivax species of malaria, which is not as fatal as other species, health officials said. Malaria is not transmitted from person to person.

—“What did Central Florida hospitals learn from Hurricane Ian?” via Caroline Catherman of the Orlando Sentinel — Eight months after a record-breaking hurricane flooded Central Florida with over 20 inches of rain and pummeled it with Category 1 force winds, health care systems are preparing to endure it all again. “We are very prepared for hurricane season. We do this every single year. We have a dedicated team of subject matter experts who live and breathe emergency management and emergency response and preparedness efforts,” said Brenna Young, emergency management manager for AdventHealth Central Florida. Alongside normal precautions such as months of preparation and ensuring adequate backup supplies and generator power, AdventHealth and Orlando Health — the region’s two biggest hospital chains — will apply new lessons learned from Hurricane Ian as the season starts on June 1.

— PENCIL IT IN —

Thursday

Happy birthday Rep. Kevin Chambliss.

Friday

8:30 a.m. — Commission on Ethics meets. Third Floor Courtroom, 1st District Court of Appeal 2000 Drayton Drive, Tallahassee. Agenda.

Saturday

Happy birthday to Rep. Jervonte ‘Tae’ Edmonds.

Monday

Happy birthday to Rep. Kimberly Daniels.

Tuesday

11 a.m. — AHCA hosts a meeting on Rule 59B-12.001 regarding bone marrow transplants. 2727 Mahan Drive, Tallahassee, Building 3, Conference Room B.

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