Diagnosis for 8.17.23: Checking the pulse of Florida health care news and policy

Ed. Note — Good morning, Florida Politics fans!

Sunburn is taking the morning off, and we are pleased to present our latest installment of Diagnosis as your morning dose of health care news, people, and policy. Don’t fear; the morning read of what’s hot in Florida politics will return to inboxes first thing Friday.

Please, enjoy — and stay safe!

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

— More managed care money —

Medicaid managed care plans are getting rate hikes in October.

While the rates still have not been finalized, draft rates shared with the state’s top health care economists show that Medicaid managed medical assistance (MMA) plans will likely see a 4.9% rate increase.

Managed dental plans are slated to receive less than a 1% increase (0.8%), while managed long-term care plans will likely see a 3.3% rate hike.

The Children’s Medical Services Plan, which contracts with the Department of Health to provide managed care to medically complex children (but is not considered part of the state’s MMA program), is slated to receive a 6.7% rate hike.

Agency for Health Care Administration (AHCA) Deputy Secretary for Health Care Finance & Data Tom Wallace shared the proposed rates with the Social Services Estimating Conference members this week.

The rates are not yet final, and Wallace said the ongoing process impacts them to remove people from Medicaid rolls following the end of the public health emergency. Wallace said the state will continue to analyze data and, if necessary, will retroactively change the rates.

Medicaid is a safety net program funded through state and federal dollars. States have significant control over operating their Medicaid programs, but there are minimum rules and requirements; one is that managed care plans be paid actuarially sound rates. To that end, AHCA, which houses the Medicaid program, contracts with Milliman to help determine the rates.

News of the rate increases came as Wallace projected a Medicaid budget deficit of nearly $600 million by June 30, 2024, of which $227 million is the state’s portion of the tab.

Wallace said to keep the program operating at current levels, Medicaid would require $934 million for the budget year that begins July 1, 2024. Lawmakers will prepare that budget when they meet in Regular Session next year.

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— Wound up by the unwinding —

As Gov. Ron DeSantis campaigns for President, his administration’s handling of the Medicaid unwinding following the end of the national COVID-19 public health emergency draws concern from regulators, advocates, and the people it’s meant to serve.

The Centers for Medicare and Medicaid Services (CMS) flagged the DeSantis administration’s unwinding plan from the public health emergency for long call wait times; high call abandonment rates; a high number of procedural disenrollments; and its lengthy redetermination process for new Medicaid applications. Florida was one of five states that failed the performance test on all four metrics, alongside Alaska, Montana, New Mexico and Rhode Island.

According to the Aug. 9 CMS letter, Florida residents who called about their benefits in May, on average, waited 32 minutes before receiving attention. The average call abandonment rate for the month was 38%, placing Florida in the bottom seven states nationwide for that metric behind Texas (52%); South Carolina (49%); Utah (48%); Nevada and New Hampshire (tied at 45%) and Washington (43%).

The DeSantis administration accused CMS of focusing on a narrow set of data and said the metrics being analyzed were outdated.

The Department of Children and Families (DCF) said the procedural termination rate for May is 7%. (Note: the figure is based on the total number of beneficiaries due for renewal in May and not the number of denials for the month.)

“Florida’s Medicaid redetermination plan was greenlighted with no changes from CMS and was not among the states recently asked to halt redeterminations,” DCF Deputy Chief of Staff Mallory McManus said in a statement emailed to Florida Politics.

“While CMS continues to attempt to smear red-state Medicaid programs, Florida is focused on ensuring care is available to those who need it the most. Florida’s top priority is serving the health and safety needs of our vulnerable populations and will not sacrifice this or change its process because of a form letter sent to all 50 states.”

But Joan Alker, executive director and research professor at the Georgetown Center for Children and Families, said the CMS letters to the states were “notable.”

“Much of the federal government’s enforcement so far has been very quiet. So, this was notable in its transparency,” Alker said Tuesday during a news conference, adding that while President Joe Biden’s administration has been working to ensure states comply with federal laws and rules, much of the enforcement until now has “not been very much out in the open.”

Alker said the federal government has a variety of tools it can use to improve the state’s unwinding efforts. CMS can and has told states to pause their Medicaid “procedural terminations.” CMS can also require states to put back into Medicaid those who were inappropriately removed due to a system error and, moreover, require the state to fix system errors. The federal government can also withhold federal Medicaid matching dollars or defer payment “and ask states to provide information.”

— Collateral damage? —

News that the Cabinet meeting scheduled for Aug. 22 had been canceled means an administrative delay for the Office of Insurance Regulation’s implementation of new pharmacy benefit manager (PBM) rules.

The Financial Services Commission, which consists of the Governor and Cabinet members, must approve a draft of the rule before the OIR can officially publish it.

Michael Lawrence, an attorney with the OIR, previously said the office wanted to have a draft of its proposed PBM rules before the commission at its previously scheduled Aug. 22 meeting.

As part of his health care legislative priorities, DeSantis earlier this year called for increased regulation over pharmacy benefit managers and making Florida laws more pharmacist friendly. The rules are part of that ongoing effort authorized by the new law passed by the Florida Legislature.

The Cabinet meeting was officially called off late last Friday after it had been noticed for several weeks and will reportedly be rescheduled for later. No official reason for the cancellation was given, but the scheduled meeting was planned in Tallahassee one day ahead of the Republican presidential debate in Milwaukee, Wisconsin.

According to some published accounts, DeSantis is scheduled to participate in the debate and is engaged in full-blown debate prep.

— More MMJ litigation —

The heir of a Black farmer who was part of a class-action lawsuit against the federal government is challenging a decision by the Department of Health (DOH) to deny her a medical marijuana license.

FTG Development, which is doing business as Earkus L. Battle, was among a group of Black farmers seeking a license from the state in 2022. Battle, who died in 2020, was part of a settlement with Black farmers who alleged they were discriminated against by the federal government concerning farm loans and aid.

The Legislature opened the door to a member of those involved in the litigation to obtain a medical marijuana license, and the DeSantis administration began accepting license applications last year.

John Allen, the president of FTG Development, agreed to obtain Battle’s assignment of rights from the litigation. But DOH denied the application in September last year, stating that FTG Development failed to prove it was part of the class-action settlement.

The company has challenged the denial in state administrative court by asserting DOH ignored the language of one of the settlement agreements that allowed rights to be assigned to heirs.

The legal filing contends this was an “invalid unpromulgated” rule violating the law.

“Ultimately, the Department’s interpretation of the term ‘recognized class member’ … has led to the wrongful disqualification of Petitioner’s status as a recognized class member as it does not conform to the federal Settlement Agreement’s definition of ‘class,’ nor did the Department promulgate a rule defining the term differently to put the public on notice.”

— Healthy partnership —

As the school year begins, two Tampa Bay-area districts have joined forces with the Central Florida Behavioral Health Network to provide K-12 students with the mental health services they need.

CFBHN, one of the state’s seven Behavioral Health Managing Entities, has therapists assigned to dozens of schools between Hillsborough and Pasco counties.

“The partnership with Central Florida Behavioral Health Network has been invaluable to Hillsborough County Public Schools. Thousands of students and families have received mental health support, and the impact has been felt across schools and the community,” said Hillsborough County Public Schools Interim Superintendent Van Ayres.

“We have been able to establish therapists at over 100 schools across the district and coordinate mental health services for students in the most appropriate setting. We continue to work with Central Florida Behavioral Health Network to create innovative ways to provide interventions in a timely and cost-effective way to individuals, seeking to break down barriers to treatment while reducing the stigma surrounding mental health.”

CFBHN said coordination is vital to ensuring youth and their families receive the services best tailored to their needs and supporting teachers, who often serve as ad hoc mental health providers in the absence of professionals.

“Today, we have 22 providers coordinating behavioral health systems of care in Pasco and Hillsborough schools, providing much-needed services to children and their families. Our providers work with children to maximize their potential in schools, so schools can focus on teaching, not addressing mental health issues,” said Central Florida Behavioral Health Network CEO Alan Davidson.

The organization asserts that its partnership with Hillsborough and Pasco could serve as a blueprint for similar arrangements in other parts of the state.

— RULES —

— AHCA proposes amending Rule 59A-18.008 to outline the requirements for certified nursing assistants and home health aides to specify the services they can provide in the home or residence. More here.

— AHCA proposes amending Rule 59G-4.085 regarding early intervention services to specify recipient eligibility, provider requirements, service coverage and reimbursement information. More here.

— The Board of Osteopathic Medicine proposes to amend Rule 64B15-13.001 to clarify its CME distance learning requirements and approve additional providers for the controlled substance prescribing course. More here.

— LOBBYISTS —

Roger Collins: Karuna Therapeutics

Christopher Finkbeiner, Rubin Turnbull & Associates: Nomi Health

Andrea Gheen, PinPoint Results: Marion Senior Services

— ETC —

— AHCA gave tentative approval on May 11 for new nursing home projects CON applications for the May 17 nursing home batching cycle. AHCA approved the application of the Hawthorne Ocala Operations certificate of need to add 22 community nursing home beds to its facility that does business as Hawthorne Center for Rehabilitation and Healing of Ocala. AHCA also approved Okahumpka SNF LLC’s CON application to establish a new 147-bed community nursing home in Lake County but denied a separate request by the same company to build a 150-bed facility in the same county. AHCA also denied Sumterlake Operations LLC’s CON for a new 116-bed facility in Sumter County. The decisions are tentative and can be appealed to the state Division of Administrative Hearings. A request for a hearing must be submitted and received by the state within 21 days of the announcement.

— With a more than 340% revenue spike, a Tampa-based health care platform company specializing in connecting nursing staff with long-term care providers has made the Inc. 5000 list of America’s Fastest Growing Companies. Tony Braswell, Gale Healthcare president and founder, attributes much of the success to what he called “exceptional tech talent” and a talent pool of 65,000 nursing professionals. “We are helping health care providers across the country overcome the nursing shortage and ensure quality care.”

— Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine was awarded a $2.5 million, five-year National Cancer Institute (NCI) grant to explore a new way to detect prostate cancer noninvasively. Sanoj Punnen, M.D., co-chair of the Genitourinary Site Disease Group at Sylvester and associate professor and Vice Chair of research, at Desai Sethi Urology Institute, is leading the study.

— ROSTER —

— Roger Duncan III, M.D., FASA, received the 2023 Florida Medical Association (FMA) Award of Distinguished Service. Working with the T. Leroy Jefferson Medical Society (TLJMS). Duncan, in 2012 founded and implemented the Healthcare and Science Stars of Tomorrow Career Symposium, which has exposed 10,000 students from underrepresented or lower socio-economic areas to potential careers in medicine, pharmacy and biomedical engineering, among others. He is the Vice Chief of Anesthesia at Palms West Hospital and the past Palm Beach Medical Society president. The Award of Distinguished Service is the FMA’s highest honor.

— Kristin Peck was elected to the Mayo Clinic Board of Trustees. Peck is CEO of Zoetis Inc., the world’s leading animal health company, and a member of the Fortune 500.

— Association for Healthcare Philanthropy (AHP) has named Taylor Baker one of its “40 under 40.” Baker is the senior development director for the Tampa General Hospital (TGH) Foundation. “Taylor is an emerging leader making a tremendous impact within our organization. Her approach to engaging our patients and the broader community has directly contributed to the advancement of our mission to heal, teach, innovate and care for everyone,” TGH President and CEO John Couris said in a prepared statement.

— ICYMI —

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

Black to red: While economists have not released final numbers, Medicaid Deputy Secretary for Health Care Finance and Data Tom Wallace projected a Medicaid budget deficit of nearly $600 million by June 30, 2024, of which $227 million is the state’s portion of the tab. Wallace said to keep the program operating at current levels, Medicaid would require $934 million for the 2024-25 budget year that begins July 1, 2024. Rep. Sam Garrison, Chair of the House health care spending panel, said the updated projections are a “possible budget challenge.” … “But thankfully, we have long established a culture of fiscal responsibility and are in a position to handle it,” he said.

Busted: This week, the 1st District Court of Appeal rejected the Department of Health’s assertions that Leafly, a third-party company that helped with online ordering, could not challenge the memo as an improperly drawn-up rule because the Washington-state-based company lacked standing. The three-judge panel also rejected DOH’s arguments that its memo wasn’t a rule and was restating existing law. Leafly hosted a website that advertised medical marijuana products sold by licensed vendors in Florida. Visitors could select products and place them in an online cart. Leafly would send the orders to MMTCs, letting Leafly know when the products were available for pickup from the center.

Go for the gold: The Florida Chamber is bringing the most decorated Olympic athlete of all time to its marquee workplace safety event next year. Michael Phelps, who has won 23 gold medals, will be the opening speaker at the 2024 Leadership Conference on Safety, Health + Sustainability, set for May 9-10 at Disney’s Contemporary Resort. While Phelps’ pool deck prowess is unmatched, the legendary swimmer has made a splash in his post-Olympics career by sharing his struggles with mental health and encouraging others — athletes and average Joes alike — to do the same. “I didn’t take care of myself fully for 20 years. By starting from the top, prioritizing mental health, doing it on a daily routine has given me the chance to become a better version of myself,” he said.

Hope On Wheels: Tampa General Hospital has received a combined $200,000 from an impact grant and regional grant from Hyundai Hope On Wheels, funds that will support the hospital’s pediatric oncology program in the fight against childhood cancer. TGH plans to use the funds to purchase interactive MRI equipment, including MRI movie goggles and a projection system. The tools will help alleviate the patient stress, fear and anxiety often associated with traditional MRI scans. By reducing those impacts, medical personnel can capture images more effectively and efficiently. Funds will also be used to offset fertility preservation costs. Specific cancer treatments, such as chemotherapy and radiation, can impact a child’s reproductive system and lead to potential fertility issues in the future. Preservation treatments provide families with peace of mind for their child’s future.

— FOR YOUR RADAR —

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

—“Ohio’s defiant embrace of democracy gives Floridians a reason to hope” via Diane Roberts of Florida Phoenix — Ohio has much to be proud of. We can add Ohio’s defiant embrace of democracy to the list of good stuff from the Buckeye State. Nobody bought the Republicans’ story that the state constitution should be held sacred, touched only by gerrymandered legislators and not amended willy-nilly by a rabble of ordinary folks laboring under the delusion that the government should work for them. But this is not about the integrity of the state constitution. It’s about abortion. Here in Florida, there’s a petition drive to pass a similar constitutional amendment. To pass, the measure needs the approval of 60% of voters. That is tough, but things could get worse in the future. Women are angry. Women are motivated. Watch this space.

—“Construction on $90 million expansion of SMH Venice Emergency Department to begin” via Earle Kimel of the Sarasota Herald-Tribune — Sarasota Memorial Health Care System will soon start construction work on a $90 million expansion of the Emergency Department and surgical facilities at the hospital’s Venice campus at the intersection of Laurel and Pinebrook roads. Plans call for increasing the size of the Emergency Department from 28 to 62 beds and the number of surgical suites from six to eight, with enough shell space to add another eight surgical suites in the future. Sarasota Memorial Hospital’s Venice campus was near capacity shortly after it opened in November 2021. The Sarasota County Public Hospital Board had approved adding a third bed tower to the campus before that.

—“FAU receives $11.5M donation for amyloidosis research: What does it mean for the school?” via Jasmine Fernández of the Palm Beach Post — Amyloidosis is a rare disease caused by the buildup of an abnormal protein. It is life-threatening, and there is no known cure. But with an $11.5 million donation to Florida Atlantic University in July, Boca Raton philanthropists Ann and John Wood will help advance research on the disease. The donation will allow the university’s Schmidt College of Medicine to create the FairfaxWood Health and Innovation Technology Initiative. The initiative will focus on the FAU Amyloidosis Project, designed to create a “game-changing infrastructure that will combat amyloidosis using a collaborative, whole-body approach,” a news release from the university said.

—“COVID-19’s comeback in SWFL: How bad is it?” via Liz Freeman of Naples Daily News — The COVID-19 comeback this Summer in Southwest Florida has been mild, with some people thinking their symptoms are allergies. What’s unclear is if a new strain of the virus, EG. 5.1. nicknamed Eris, is to blame. The more populous Lee County is seeing more cases than Collier County, but that’s consistently been the trend since the start of the COVID-19 pandemic in Spring 2020. According to the state Department of Health, Lee saw 610 new cases for the week ending Aug. 3, a 61% increase from 379 cases the week ending July 20. The data is reported every two weeks.

—“Injecting a gene into monkeys’ brains curbed their alcohol use” via Emily Mullin of WIRED — In a study published today in the journal Nature Medicine, they found that an experimental therapy injected into monkeys’ brains dramatically curbed their drinking over a year. Researchers gave gene therapy to four rhesus macaques given increasing doses of alcohol until they developed an addiction. The animals were then allowed to drink as much as they wanted. The first time alcohol was reintroduced, the monkeys who had received the gene therapy decreased their drinking by about 50% compared to a control group of monkeys that didn’t get it. Every time researchers reintroduced alcohol after an abstinence period, the animals that got the gene therapy drank less than they did before the treatment.

— PENCIL IT IN —

Thursday

Noon — The Florida Department of Health Division of Community Health Promotion is conducting the Rare Disease Advisory Council State Agencies subcommittee meeting online via Microsoft Teams. Or call (850) 792-1375; participant code 340051939#.

Happy birthday to Sen. Ben Albritton and former Rep. Vance Aloupis.

Friday

9 a.m. — General Revenue Estimating Conference. 117 Knott Building in Tallahassee.

Sunday

Happy birthday to U.S. Rep. Kathy Castor and former Attorney General Bob Butterworth.

Tuesday

1:30 p.m. — The Florida Board of Medicine’s Council on Physician Assistants is holding a telephone conference. Call (571) 317-3112; participant code: 717632629.

2 p.m. — The Commission on Mental Health and Substance Abuse Disorder holds a virtual meeting via Microsoft Teams. Or call (412) 912-1530; participant code: #374247625

Happy birthday to Rep. Kristen Arrington and Sen. Dennis Baxley and Rep. Gallop Franklin and former Sen. Bill Montford

Wednesday

10 a.m. — AHCA holds a rule development workshop on proposed Rule 59G-4.127 regarding Florida Assertive Community Treatment Services. 2727 Mahan Drive, Building 3, Tallahassee.

Happy birthday to U.S. Rep. Scott Franklin and former Rep. Margaret Good.

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