Diagnosis for 6.28.23: 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.

— Waiting game —

A tentative deadline for the Agency for Health Care Administration to provide additional insight into its Statewide Medicaid Managed Care program came and went this week.

The agency had tentatively planned to respond by June 27 to written questions about its invitation to negotiate (ITN). It’s unclear when AHCA will post the questions and answers and the agency didn’t immediately respond to Florida Politics’ questions about the timeline.

Some health plans were surprised by a provision in the ITN regarding enrolling individuals with intellectual or developmental disabilities into the Statewide Medicaid Managed Care program.

Managed care plans and other entities interested in participating in Florida’s Medicaid program had until May 3 to submit questions to AHCA. Florida Politics first requested the names of the entities that submitted queries and a copy of the questions in early May. AHCA has not provided the information.

AHCA will invite 10 plans to negotiate for the Medicaid managed care contracts. The contracts are worth tens of billions of dollars to the entities that submit winning bids. Those that don’t are shut out of Florida’s Medicaid program.

AHCA also has not publicly released the names of the entities responding to the Medicaid prepaid dental program request for information (RFI). AHCA posted the RFI May 15 and set the deadline for responses for May 30.

Respondents were required to submit two responses to the RFI, one electronically with any proprietary information redacted so that it could be released to the public. The RFI required respondents to send with the redacted response a transmittal letter “authorizing release of the redacted version of the Response in the event the Agency receives a public records request.”

At press time, AHCA had yet to provide Florida Politics with a copy of the responses.

— Stay safe —

Floridians spend much time outside on the Fourth of July, especially in the early evening when they gather to watch those spectacular fireworks displays.

But this year, the discovery of four local malaria cases in Sarasota County prompted a statewide mosquito-borne illness advisory by the Florida Department of Health that calls on residents to take some steps to reduce their risk of getting bitten.

Those steps include “applying bug spray, avoiding areas with high mosquito populations, and wearing long pants and shirts when possible — especially during sunrise and sunset when mosquitoes are most active.” In other words, don’t wear shorts to the park when you celebrate Independence Day.

The Centers for Disease Control and Prevention reported earlier this week that five malaria cases have been identified nationally — four in Florida and one in Texas.

The CDC noted that locally acquired mosquito-borne malaria had not occurred in the United States since 2003 when eight cases were identified in Palm Beach County. Malaria cases are typically imported and occur in people who have traveled from sub-Saharan Africa and South Asia.

Malaria is a serious and potentially fatal disease that the CDC notes can start displaying symptoms from 10 days to four weeks after infection. In its advisory, the CDC said it was conducting investigations into the cases in Texas and Florida in concert with health departments in both states.

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

— Living for life —

AARP Florida is awarding Community Challenge grants to eight organizations for “quick action projects” that make Florida’s cities and spaces more livable for everyone.

Three grantees — Habitat for Humanity of Hillsborough County, the City of Orlando, and Miami Center for Architecture & Design (MCAD) — will use their grants for education and outreach on Accessory Dwelling Units.

ADUs are smaller rental spaces ancillary to a principal residence, such as a mother-in-law suite over the garage. ADUs were popular in the 1950s and 1960s but have fallen out of favor. With the rise of smaller households, one-person households and an aging population, coupled with an affordable housing crunch, there has been a resurgence of interest in ADUs.

Habitat for Humanity of Hillsborough County sponsors an ADU design competition where teams from local architecture firms and high school and college architecture programs present ADU plans. MCAD uses its grant for an ADU design competition focusing on the 50-plus community.

Other projects receiving grants:

— The City of Tallahassee KCCI-Knight Creative Communities Institute also was chosen to receive a quick action grant to fund a community event focused on painting two crosswalks that connect an elementary school and a senior living community. The painted sidewalks improve traffic and pedestrian safety.

— The Apalachee Regional Planning Council will use its quick action grant to provide “Wills on Wheels” mobile legal clinics to a nine-county region in North Florida.

— The City of Lakeland will use its money to create a safe, ADA-compliant walkable connection from Florida Avenue to Drane Park, connecting three other bike and pedestrian routes that pedestrians can use to access facilities and trails.

— Lee County will use its money for the “Keep Lee County Beautiful” project to re-establish the tree canopy lost during Hurricane Ian in a park that hosts the local 50-plus softball league.

— Florida City is using its grant to fund “Sprout,” a program focusing on aeroponic gardening and bringing local seniors and residents together to cultivate the garden.

“AARP Florida is committed to working with local leaders to improve residents’ quality of life through tangible changes,” said AARP Florida State Director Jeff Johnson. “We are proud to collaborate with this year’s grantees as they make immediate improvements in their communities to jump-start long-term change, especially for Floridians 50 and over.”

The grant program is part of AARP’s nationwide Livable Communities initiative. Since 2017, AARP Florida has awarded 42 grants and $524,128.

— DeSantis strikes back —

A pair of rulings regarding access to gender-affirming care from federal Judge Robert Hinkle is being appealed to the 11th Circuit Court of Appeals. Attorneys for the state filed paperwork with the Atlanta-based appellate court Monday.

The state is appealing a preliminary injunction Hinkle issued earlier this month allowing three transgender children to receive puberty blockers even though they had not started treatment before May 18, when the law banning gender-affirming care for minors took effect.

The preliminary injunction only impacts the three transgender children and enjoins the state from prosecuting the physicians who provide the children’s health care.

The state also is appealing Hinkle’s ruling that a law and rule that bans Medicaid from paying for transgender care — specifically puberty blockers and hormone therapy — violates the Equal Protection Clause of the United States Constitution and two federal health care laws. DeSantis, who is running for President, made banning gender-affirming care for children and limiting adult access, a top priority last summer. Florida Surgeon General Joseph Ladapo petitioned the state’s medical boards to amend their standard of care rules to ban the care for minors and disallow Medicaid reimbursement for the care because it is “experimental.” The Legislature passed a bill that codified those policies into law during the 2023 Session.

According to Hinkle’s Medicaid ruling, the Governor’s Office requested Medicaid conduct a new generally accepted professional medical standards (GAPMS) report and hired an outside firm to do the work. Hinkle said the report was “from the outset, a biased effort to justify a predetermined outcome, not a fair analysis of the evidence.”

Meanwhile, the two state medical boards have issued emergency rules that allow transgender children who were in treatment before May 18 to continue to have access to their prescriptions for six months, or until the boards can adopt the new informed consent forms patients must sign before receiving the care.

— Scott questions Chinese drug importation —

U.S. Sen. Rick Scott joined two other Senators in raising questions to the Food and Drug Administration (FDA) over cancer drug shortages and a recent announcement that federal regulators will temporarily allow the importation of an unapproved version of one drug made in China.

Cancer patients have been grappling with a shortage of several drugs, part of which has been blamed on a production halt by an Indian company. The company halted production after the FDA discovered safety and quality violations.

The three Senators who signed the letter serve on the U.S. Senate Special Committee on Aging.

“This use of a Chinese-approved product without adequate vetting, labeling or communication may cause frustration among health care providers and patients and is especially inappropriate while we are still discovering the truth about China’s role in the COVID-19 pandemic,” the letter signed by Scott, Indiana Republican Sen. Mike Braun and Ohio Republican Sen. J.D. Vance.

“America is still waiting for President Biden to declassify all intelligence related to any link between the Wuhan Institute of Virology and the COVID-19 virus, as required by law.”

The letter also called on the FDA to update the three Senators by July 21 on how the agency is “addressing the needs of older adults who are impacted by drug shortages today, and how to ensure they will have better access to critical treatments when emergencies arise.”

— RULES —

—The Board of Osteopathic Medicine published emergency rule 64B15ER23-4 regarding sex-reassignment prescriptions allowing a patient’s prescribing physician to for six months renew prescriptions that were initially prescribed before May 17.

— LOBBYISTS —

Elizabeth Dudek, Greenberg Traurig: NTT DATA State Health Consulting

Kelly Smith, Jennifer Ungru, Dean Mead: One Source Medical Group

— ETC —

— Three Florida health care organizations were able to tap into federal funds to implement a Teen Pregnancy Prevention (TPP) program. Fit Kids of America Corp, OIC of South Florida, and Planned Parenthood of South Florida and the Treasure Coast were recipients of the new five-year grants. Grants ranged in size from $350,000 to $2 million. The goal of the program is to improve sexual and reproductive health outcomes, promote positive youth development, and advance health equity for adolescents, their families, and communities through the replication of medically accurate and age-appropriate evidence-based teen pregnancy prevention programs and services. Funding is available July 1.

— AHCA received and accepted three Certificate of Need (CON) ICF/DD nursing home applications for review. Hawthorne Ocala Operations d/b/a Hawthorne Center for Rehabilitation and Healing of Ocala wants to add 22 community nursing home beds in Marion County. Okahumpka SNF intends to establish a new community nursing home of up to 150 beds in Lake County. And Sumterlake Operations wants to establish a new community nursing home of up to 116 beds in Sumter County.

— Progressus Therapy, a wholly-owned subsidiary of Invo Healthcare, is closing its Florida facilities. More than 400 people will lose their jobs, according to a WARN notice filed with the state. Layoffs will occur between Aug. 21 and Sept. 19. “Unfortunately, challenges faced through and following the pandemic have led us to a place where the quality we committed to would be at risk,” the notice reads. “After spending the last year and a half on multiple initiatives, operational upgrades and potential alternatives to keep our Applied Behavior Analytics home and center-based operations intact, we ultimately came to the difficult decision to discontinue this aspect of our business.”

— Covenant House in Orlando closed its Safe Haven Emergency Residential Shelter June 28. According to the WARN notice filed with the state, 22 people lost their jobs: “Covenant House Florida opened its doors 40 years ago in Fort Lauderdale to provide hope to young people experiencing homelessness and survivors of human trafficking. Since 1995, Covenant House Florida has been meeting the needs of youth experiencing homelessness in the Central Florida Community.” Unfortunately, due to budgetary challenges, the notice reads that Covenant House Florida has decided to permanently close its emergency residential shelter in Orlando.

— ROSTER —

— John Couris, president and CEO of Tampa General Hospital, has accepted an offer to extend the terms of his employment by 10 years.

— Lijah Lokenauth, vice president of accounting and finance at Tampa General Hospital, made Tampa Bay Business & Wealth’s 2023 “Up & Comers” list. Before rising through the ranks, he joined Tampa General’s financial team in 2018 as a corporate comptroller.

— Mike Murrill was named president and CEO for AdventHealth Zephyrhills, AdventHealth Dade City and AdventHealth Connerton in Pasco County. Murrill starts work July 30.

— ICYMI —

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

Rejected: A federal judge has invalidated a rule and law barring Florida from having Medicaid pay for gender-affirming care provided to transgender individuals. U.S. District Judge Robert Hinkle concluded that the ban on Medicaid payments violated two federal health care laws and the Constitution’s Equal Protection clause. Wednesday’s ruling applies to the state’s $38 billion Medicaid program and the roughly 9,000 transgender enrollees. “Gender identity is real. Those whose gender identity does not match their natal sex often suffer gender dysphoria,” Hinkle wrote. ” … Florida has adopted a rule and statute that prohibit Medicaid payment for these treatments even when medically appropriate.”

Fast start: In the last year, a right granted 50 years ago was gutted and stands to be rolled back even further to the point that abortion will not be an option for most pregnant women in the state. For anti-abortion advocates, it’s a win they have been working toward since Republicans gained control of state government more than two decades ago. But frustration among critics has borne a new organization: Floridians Protecting Freedom. It aims to circumvent the Governor and the Legislature and allow Florida voters to weigh in on the thorny question of abortion rights in the 2024 General Election. With 240,000 signatures from registered voters already collected, optimism abounds.

One of the best: The University of Florida Health Cancer Center has met the rigorous National Cancer Institute (NCI) designation requirements. The UF Health Cancer Center is the 72nd cancer center to achieve the designation in the United States and becomes the fourth in Florida to earn the prestigious honor. The designation sharpens UF Health Cancer Center’s competitive edge when seeking cancer research grants. It brings an annual $2 million commitment from the NCI for the university to help attract more world-class researchers and clinical investigators. “This is a big deal — and it’s going to make a difference for many of Florida’s families as their loved ones fight cancer,” UF President Ben Sasse said.

Pass the DEET: The Department of Health (DOH) issued a statewide mosquito-borne illness advisory after four malaria cases were confirmed in Sarasota County. Malaria symptoms usually appear 10 days to one month after infection. DOH officials encourage anyone in the area to seek medical attention. Parasites that enter your body through the bite of an infected mosquito cause malaria.

Refill, please: DeSantis signed legislation to extend telehealth renewals on medical marijuana and ensure more Black farmers participate in the industry. The bill (HB 387) had bipartisan support in the Florida Legislature, though the tying of two issues together at times put the legislation on uneasy footing. The bill’s original version focused on extending the ability to renew medical prescriptions for cannabis remotely. But in the final days of the Session, lawmakers also addressed a long-pressing legal commitment to authorized medical marijuana licenses for a dozen Black farmers.

— FOR YOUR RADAR —

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

—“AARP Florida report says nursing home staffing levels are declining, which means ‘loss in quality of care’” via Cindy Krischer Goodman of the Orlando Sentinel — If you have a loved one in a Florida nursing home, you may want to tailor your expectations for the amount of hands-on care they receive. Staffing levels in the state’s 700 nursing homes have declined after changes to Florida law over the past two years. First came the Florida law passed in April 2021 that created a new class of nursing home workers, called personal care attendants, who could do the job of certified nurse assistants without training while learning on the job.

—“What the DeSantis fentanyl plan owes George W. Bush” via Olivier Knox of The Washington Post — Not Bush’s “either you are with us, or you are with the terrorists” theory of the case. But DeSantis (and many of his rivals for the 2024 Republican presidential nomination) have embraced the former President’s “unwilling or unable” doctrine, knowingly or not. As Bush wrestled with how to respond to the Sept. 11, 2001, attacks, he and his team decided unilateral U.S. military action on the territory of another country would be justified if that country’s government were unwilling or unable to take on extremists eager to attack America. So, what’s the DeSantis approach to fentanyl? Part of it, Kit Maher and Steve Contorno reported on CNN that part of it is unilateral action on Mexican soil, whether the government there likes it or not.

—“UF Health ‘breaks ground’ on new east Gainesville care center in unusual fashion” via Nora O’Neill of The Gainesville Sun — Community leaders broke ground Wednesday on a new University of Florida Health Urgent Care Center in possibly the most unorthodox way. No shovels were pressed into the dirt, no hard hats and no posing for pictures. It wasn’t even at the planned east Gainesville location. Gainesville, Alachua County and UF Health officials celebrated the groundbreaking of the highly anticipated 9,000-square-foot urgent care facility early Wednesday morning. The $5.7 million center, which is set to open in mid-2024, will provide much-needed emergency services for a population with some of the county’s worst health outcomes.

—“UCF announces $10 million pledge from AdventHealth, Orlando Health for new nursing college facility” via Silas Morgan of the Orlando Sentinel — The University of Central Florida announced Thursday that AdventHealth and Orlando Health are contributing a combined $10 million to help construct a new $70 million building for UCF’s College of Nursing in Lake Nona to address Florida’s nursing shortage. The $10 million contribution is the latest development in UCF’s long-standing partnerships with the two health care organizations, which are the first members of UCF’s new Pegasus Partners program. The program allows member organizations to engage with UCF, including talent development and recruitment, shared research projects, joint ventures and collaborations and strategic philanthropy.

—“Pickleball injuries may cost Americans nearly $400 million this year, according to UBS” via Joe Weisenthal of Bloomberg — Earlier this month, shares of big health insurance companies fell after UnitedHealth Group warned that health care utilization rates were up. At a conference, the company had said it saw a higher-than-expected pace of hip replacements, knee surgeries and other elective procedures. In a new note, UBS Group AG analysts led by Andrew Mok offer a surprising theory about one factor driving a higher pace of injuries: pickleball. The firm estimates $250-500 million in costs attributable to pickleball injuries in 2023. They conclude that pickleball players go to emergency departments at a rate of about 0.27%, with most injuries occurring among those 60 years or older.

— PENCIL IT IN —

Thursday

2:30 p.m. — The Medicaid Medical Care Advisory Committee HIV/AIDS Subcommittee meets. Email [email protected]. Call (850) 792-4898; participant code: 447538049.

Friday

Happy birthday to Sen. Erin Grall.

8:30 a.m. — Centene Corporation holds a conference call to discuss its 2023 second quarter financial results, which will be released at approximately 6 a.m. Call (877) 883-0383; participant code 6765870. Or watch a live webcast on Centene’s website.

Tuesday

Happy Fourth of July.

Happy birthday to Rep. Tiffany Esposito and Rep. Randy Maggard.

Wednesday

Happy birthday to Rep. Michelle Salzman.

1 p.m. — The Medicaid Medical Care Advisory Committee (MCAC) Dental Subcommittee meets. Call (850) 792-4898; participant code: 17920217. Email [email protected] for a copy of the agenda.

3 p.m. — The Medicaid Medical Care Advisory Committee (MCAC) Long Term Care, Managed Care Subcommittee meets. Call (850)-792-4898; conference ID: 339161130. Email [email protected] for a copy of the agenda.

3 p.m. — The Florida Trauma System Advisory Council meets via Microsoft Teams. Meeting ID: 283349286040. Passcode: ChMeHN. Video Conference ID: 1117681903. Or call (850) 792-1372; participant code: 284814432.

___

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