Diagnosis for 8.2.23: 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.

— A slow grind —

Sometimes the gears of state government grind slowly … but other times, it seems they can move quickly — especially if it is a top priority of Gov. Ron DeSantis.

Look at how state agencies under the Governor have conducted the implementation of several health care policies over the last couple of years, including rules needed to put in place new regulations for pharmacy benefit managers (PBMs) and those affecting gender-affirming care.

There is a noted contrast between how those rules are being put into play versus regulations authorized by the state Legislature for the nursing home industry.

Let’s take a closer look:

The Florida Legislature first took steps in 2021 to require nursing homes to report their audited financial data and that of their corporate offices to a state database. The nursing home industry opposed the effort at the time, and the result was instead a requirement for a nursing facility’s “actual financial experience” to be submitted to the database, dubbed the Florida Nursing Home Uniform Reporting System.

The following year, Sen. Jay Trumbull, who chaired the House’s spending committee at the time, filed legislation to require the financial data to be audited and, unlike the previous year, the nursing home industry did not oppose the change.

But the rules needed to make financial reporting a reality and create the database have yet to be finalized by the Agency for Health Care Administration.

AHCA has not commented on why the necessary rules haven’t been finalized, but Communications Director Bailey Smith noted that the state held a meeting July 20.

One lobbyist attributed the delay, at least partly, to a lack of interest. “No one is at home running on this issue,” the lobbyist said.

But former Rep. Carlos Guillermo Smith says that’s unacceptable.

“The spirit of the law needs to be respected and implemented, which is financial transparency and accountable for-profit nursing homes,” said Smith, a Democratic who is running for a state Senate seat that will open up next year.

Smith worked with Republican leadership in 2021 and 2022 on the transparency requirements issue. He argues that the nursing facilities, which received about $6 billion in reimbursements in the fiscal year 2021-22, should be required to report their audited financials to the state.

Hospitals have been required to report their audited financial reports to a state database called the Florida Hospital Uniform Reporting System, or FUHRS, since 1992.

“The public deserves to know what they are doing with that money. If they are not submitting the audited financial reports as they are required, then the spirit of the law is not being enforced, and that’s wrong,” he said.

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— A quick grind —

If audited financial reports aren’t headline-grabbing, PBM regulations are.

The Office of Insurance Regulation (OIR) has started implementing the rules to make the new PBM law a reality.

OIR is holding a workshop Friday on a few proposed new PBM regulations, including the applications for the certificate of authority as an insurance administrator and pharmacy benefit manager renewal; remittance requirements; independent professional examiners; and annual insurance reports.

The proposed rules don’t appear to stretch beyond the statutes, lobbyists say, but some health plans could ask some questions at the meeting.

The meeting will be in Room 116 Larson Building, 200 East Gaines Street, Tallahassee. Those who can’t attend the Larson Building meeting can join by calling (850) 328-4354; participant code: 68054875.

— A quicker grind —

Meanwhile, the rules on access to gender-affirming care appear to be moving at lightning speed.

The Board of Medicine (BOM) and Board of Osteopathic Medicine (BOOM) will hold a public meeting Thursday on proposed rules laying out the standard of care for gender-affirming care for adults and children.

While the permanent rules are workshopped, the boards last month adopted emergency rules regarding the standard of care for minors and informed consent forms for minors and adults.

Emergency rules take effect immediately, but Joint Administrative Procedures Committee Chief Attorney Marjorie C. Holladay has flagged problems in the informed consent forms the boards adopted June 23.

The emergency rules require adults to undergo a “thorough psychological and social evaluation” before receiving hormone replacement therapy. The emergency rules require that a Florida-licensed, board-certified psychologist perform the valuation and that the evaluations be conducted before an adult takes “feminizing” or “masculinizing” hormones and completes the assessment every two years after that.

“Please explain the board’s statutory authorization …,” Holladay wrote in separate letters to the Attorney General’s legal staff, representing the boards.

But Holladay didn’t stop there. She also flagged what she called in the informed consent rules “substantive requirements” for adults to receive hormone replacement therapy.

Holladay said Florida law requires the informed consent forms to provide “information regarding the nature and risks of the prescription and an acknowledgment from the patient. It appears that substantive requirements for hormone replacement therapy should be in the rule text, not the informed consent form,” she wrote in the letter.

The joint board’s Thursday meeting will focus on moving ahead with permanent rules regarding informed consent and standard of care for gender dysphoria in minors and adults.

— A legal grind —

A South Florida abortion clinic is disputing a complaint filed against it by the Agency for Health Care Administration. It will square off against state regulators in a September administrative hearing.

The complaint dates back to last year when AHCA alleged that Hialeah Women’s Center had not adequately informed patients of the risks associated with abortion at least 24 hours ahead. AHCA surveyed the clinic in May 2022 and said its regulators could not find documentation that 40 patients were told ahead of time of potential complications that could arise from the procedure and that an administrator at the clinic acknowledged there was no documentation.

AHCA sought to fine the clinic $40,000, or $1,000 for each violation cited in the complaint.

The clinic, however, challenged the fine in June, saying in its initial filing that it would dispute the idea that there is “no” documentation that the clinic followed state law or that the administrator acknowledged there was no documentation. So far, attorneys for the clinic have not filed any detailed information explaining the basis for the challenge.

A two-day hearing is set for Sept. 25 and 26.

AHCA has issued several complaints against abortion clinics in the last two years.

— On the grind —

During its recent Annual Conference, Florida Health Care Association members re-elected Anita Faulmann as president.

Faulmann is Regional Director of Operations-Florida for Excelsior Care Group, which manages nine skilled nursing and rehabilitation facilities across Florida. As President, Faulmann will lead the Association’s 30-member Board of Directors, which includes 16 District Presidents from across the state.

“I believe that as leaders in the long term care profession, it’s our responsibility to paint a compelling picture of the future and motivate others to be part of it,” said Faulmann. “My goal is to continue engaging our membership to inspire the next generation of leaders, so this profession remains strong, and Florida continues setting the gold standard for high-quality, long-term care.”

Faulmann has worked in long-term care for over 35 years, first as a recreational therapist, then quickly moving up the career ladder to nursing home administration and directing regional operations.

Faulmann has spent most of her career actively involved with FHCA. She has previously served on the FHCA Executive Committee as senior vice president, treasurer, and secretary and has also chaired the association’s Workforce and Annual Conference committees.

She is also a graduating member of the FHCA Florida Leaders program and the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Future Leaders in Long-Term Care.

Alongside Faulmann, the following FHCA Executive Committee members were elected:

Senior Vice President Julie Morris; Treasurer Joshua Wagoner of North Campus Rehabilitation and Nursing Center; Secretary Patricia Spears of Topaz Fiscal Services; Not-for-Profit Vice President Connie Bend of St. Catherine Laboure’ Place; Independent Owner Vice President Jeffrey Freimark of Miami Jewish Health; Member at large Mel Beal of Facility Support Company; and Immediate Past President Marco Carrasco of Miami Shores Nursing and Rehab Center.

— RULES —

— The Board of Osteopathic Medicine is amending Rule 64B15-13.001 to clarify and update continuing medical education requirements, including obtaining completion of CME in a distance learning format and approving an additional provider for the controlled substance prescribing course. More here.

— The Board of Chiropractic Medicine proposes new Rule 64B2-18.0055 to create language requirements for continuing education. More here.

— OIR proposes amending rule 69O-193.003 to update the applications for a provisional certificate of authority for a continuing care provider, a certificate of authority for a continuing care provider, an expansion of a certificated continuing care facility; the simultaneous acquisition of a continuing care facility and issuance of a certificate of authority to a provider; and a consolidated application for a provisional certificate of authority and certificate of authority for a continuing care provider. These changes remove the invoices from these forms, which are no longer needed due to changes in payment processing, improved formatting, updated instructions, corrected typographical errors, and updated addresses. More here.

—LOBBYISTS —

Robyn Blank, The Griffin Group: Florida Alliance of Home Care Services, FullBloom

Vance Coley, PinPoint Results: ReadiNet

James McFaddin, The Southern Group: ArchWell Health Medical Group of Florida

— ETC —

— Over the last decade, the number of reported leprosy cases has more than doubled in the southeastern states. According to the National Hansen’s Disease Program, 159 new cases were reported in the United States in 2020; Florida was among the top reporting states. Specifically, Central Florida accounted for 81% of cases reported in Florida and almost one-fifth of nationally reported cases. Read an interview with an Orlando physician who reported the cases here.

— After CVS Health’s year-over-year profits for the second quarter fell by 37%, the company announced a systemwide restructuring. CEO Karen Lynch said the restructuring should be complete by the end of the year and should generate more than $600 million in savings. Despite the losses, CVS’ Q2 profits topped expectations.

— Centers for Disease Control and Prevention Director Dr. Mandy Cohen, M.D., has been on the job for about a month. In an interview with All Things Considered, Cohen shared her plans to rebuild public trust in the CDC. More here.

— ROSTER —

— HCA Florida Woodmont Hospital named Cory Mead its new Chief Executive Officer. Meads has previously worked at HCA Healthcare’s MidAmerica Division, having held the COO post at HCA facilities in Tennessee and working as an associate COO in Virginia. He also was a director of operations at a Missouri hospital. Mead earned a bachelor’s and master’s degree in health administration from the University of Iowa.

— Meean P.A. shareholder Joy M. Ryan received the Mark Trafton Distinguished Service award at the Florida Insurance Council’s annual retreat Ryan, FIC’s lead life and health insurance lobbyist, was in the trenches on the PBM legislation during the 2023 Session. FIC established the award in 2011, naming it after its longtime lobbyist Mark Trafton.

— The Palm Beach County office of the American Heart Association announced Grasford W. Smith, J.D. and Fontaine Timmer, DNP, are the board Chair and president, respectively. T: Alina Alonso, M.D., and Rebecca Doane, J.D., CPA, also joined the board.

— ICYMI —

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

Slight dip: The month of June saw about a 2% reduction in the number of residents enrolled in Medicaid, the health care safety net program for the elderly, poor and disabled. That’s a far smaller drop than what the DeSantis administration was expecting. A recently published report shows that as of June 30, 5,427,530 people were enrolled in Medicaid as the state continues to “unwind” from the public health emergency (PHE). That figure includes 8,287 children enrolled in an optional Medicaid expansion program called MediKids.

Testing the waters: The state wants to test whether a Medicaid managed care model would better serve people with intellectual and developmental disabilities. Officials want to try out the idea in some of the most heavily populated regions of the state: Hillsborough and Miami-Dade counties. Unlike other Medicaid managed care programs where enrollees have at least two managed care plans to choose from, AHCA is only required to contract with one plan, meaning no choice of providers. The pilot program is accepting up to 600 volunteer individuals with intellectual and developmental disabilities. It’s being launched in Medicaid Regions D and I. Region D consists of Hardee, Hillsborough, Highlands, Manatee and Polk counties. Region I is made up of Miami-Dade and Monroe counties.

Never forget: As Sunshine State seniors plod through Facebook posts, national Democrats plan to reach them with a simple message: Don’t trust U.S. Sen. Rick Scott with your future benefits. Democrats in the Midterms painted Scott’s “Rescue America” policy blueprint as an attack on Medicare and Social Security. A new digital ad against the incumbent Republican strikes the same tone while retreading a well-worn critique of Scott’s private sector background. The “FL Memories” ad asks seniors to recall all the times Scott’s name appeared in a headline alongside the word Medicare. “You’ve got memories with Rick Scott,” the narrator states.

The streak continues: Tampa General Hospital (TGH) remains a beacon in health care excellence as the 2023-2024 U.S. News & World Report results show once again that the academic health center is one of the best hospitals in the nation. It marks the seventh year TGH has earned the top spot in Tampa Bay. Statewide, TGH is the #4 highest-ranked hospital in Florida and placed in the top 20 nationally in three specialties — obstetrics and gynecology, gastroenterology and GI surgery, and diabetes and endocrinology. “Tampa General’s recognition as a national leader in health care year after year is a direct result of the unwavering commitment by our entire team to deliver world-class care at every level and across all specialties to our patients and our community every single day,” said Tampa General President and CEO John Couris.

—FOR YOUR RADAR —

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

—“In blistering order, judge tells Florida to stop blocking effort to aid medically frail kids” via Carol Marbin Miller of the Miami Herald — The battle of wills between Florida health administrators and a federal court judge intensified Tuesday as U.S. District Judge Donald M. Middlebrooks accused the state of obstructing his efforts to free medically fragile children from segregated institutions, where many have spent their entire lives. Late last week, the Florida Agency for Health Care Administration asked Middlebrooks to stay an injunction he signed a week earlier requiring the state to reform its system of care for 2,750 children with medical complexities. The linchpin of Middlebrooks’ plan is a requirement that the state ensures such children receive at least 90% of the at-home nursing care prescribed by their doctors.

—“Tampa advocates work to launch health center and fight misinformation over immigration law” via Juan Carlos Chavez of the Tampa Bay Times — Nancy Hernandez delivers food and provides counseling to needy people at her office along Nebraska Avenue. Twice a week, families wait patiently in their vehicles. Many arrive two hours early. Some walk there. Senate Bill 1718 was approved by the Florida Legislature and signed by DeSantis in May. The legislation, which took effect July 1, is considered among the nation’s harshest crackdowns on illegal immigration. Among other provisions, the law requires hospitals that accept Medicaid to ask about patients’ immigration status during the admissions process. Local hospitals have assured us that this information will not affect their care or result in a report to immigration authorities. But immigrants without proper documents are afraid to go to the hospital due to this provision, said Hernandez, and don’t want to take a risk, even when the person can decline to answer that question.

—“Manatee County officials deny funding to LGBTQ+ program for kids’ mental health” via Ryan Callihan of the Bradenton Herald — Manatee County officials singled out and denied funding for an LGBTQ+ organization as they approved millions of dollars in funding for other community programs that support local children. Commissioner Amanda Ballard raised the issue, noting that she disagreed with a recommendation to fund a mental health counseling program for ALSO Youth, which provides resources to LGBTQ+ children in the area. Earlier this year, Ballard also pushed for restricted access to LGBTQ+ content in libraries. “In speaking with them, I was not convinced that the counseling they are going to provide will not be focused on helping or encouraging children into a gender transition or making them more uncomfortable with their gender situation,” Ballard said.

—“DeSantis promises to prosecute Anthony Fauci if elected President” via Caroline Downey of the National Review — The Governor said the former White House chief medical adviser misled the public about the severity of COVID and the efficacy of mitigation measures. Asked whether he would prosecute Fauci if he were elected, DeSantis replied emphatically: “Yes!” “He is guilty of lying before Congress.” DeSantis pointed out that “one of the problems we have in D.C.” is that “bad jury pools” favor Democratic officials and disadvantage Republican officials during the accountability process. As a result of the skewed judicial situation there, “Fauci would be protected in that,” he said. “That would be a huge hurdle.”

—“Historic heat adds peril for Central Florida’s homeless population” via Ryan Gillespie of the Orlando Sentinel — Michele Davis knows all about the oppressive July heat, the hottest in Central Florida’s history. Davis sleeps on the streets of Parramore amid a growing population of unsheltered people. She’s been unhoused for four months for the first time in her life. She came to Orlando with her fiancé to be near his mother, who has health issues. “It’s miserable,” said Davis, 50. “When that sun starts beaming, it’s difficult for you to lay down because the sun is right on you. And the ground is hot.” This Summer, the streets are more treacherous than normal, with Florida off to its hottest start of the year in history. In July, temperatures averaged 85 degrees.

— PENCIL IT IN —

Thursday

2 p.m. — AHCA holds a workshop on proposed Rules 59A-36.019 and 59A-36.025 regarding emergency management and emergency environmental control for assisted living facilities, respectively. 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, 32308. Or call (888) 585-9008; participant code: 998518088. Agenda here.

2 p.m. — The Boards of Medicine and Osteopathic Medicine’s Joint Surgical Care/Quality Assurance Committee hold a joint rule hearing on proposed changes to Rules 64B8-9.009; 64B8-9.001; 64B15-14.007; and 64B15-14.0076 regarding the standard of care for gluteal fat grafting procedures performed in-office surgery facilities considering CS/CS/HB 1471. Agenda here.

4 p.m. — The Boards of Medicine and Osteopathic Medicine’s Joint Legislative/Rules Committee meets to workshop proposed new rules relating to the standard of care for the treatment of gender dysphoria in minors and informed consent forms for minors and adults. The group also will discuss physician assistant licensure. Agenda here.

Friday

8 a.m. — Florida Board of Medicine meets. Renaissance Orlando Airport Hotel. Agenda here.

10 a.m. — The Office of Insurance Regulation holds a workshop to develop Rules 69O-197.001; 69O-197.004; 69O-197.005, and 69O-197.006 regarding the application for a certificate of authority as an insurance administrator and pharmacy benefit manager renewal; remittance requirements; independent professional examiners; and insurance administrator annual report, respectively. 116 Larson Building, 200 East Gaines Street, Tallahassee. To join by telephone, call (850) 328-4354; participant code: 680454875.

Saturday

11 a.m. — Molina Healthcare of Florida, Young Dreams Community Outreach and City of Miami Commissioner Alex Diaz de la Portilla are giving backpacks and supplies to more than 1,000 students in the Miami area at a back-to-school event. Molina will host community activities, including bean bag toss and hula hoop game. Juan Pablo Duarte Park, 1776 NW 28th St. Miami, 33142. Email [email protected] or call (561)-365-0913 for more information.

Tuesday

2:30 p.m. — The Division of Community Health Promotion, Bureau of Tobacco Free Florida meets to discuss cancer prevention, control, and research. 2585 Merchants Row Blvd. Room 310-A, Tallahassee. Email [email protected] or call (850) 245-4050 for a copy of the agenda.

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