Diagnosis for 08.30.23: 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.

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— ‘Major hurricane’ hits —

Hurricane Idalia smashed into Florida early Wednesday as a “major hurricane” but ahead of the storm dozens and dozens of health care facilities evacuated— and so far, there have been no reports of any problems.

Florida Health Care Association (FHCA) Senior Director of Strategy and Communications Kristen Knapp said citing figures that had been given to her by the Agency for Health Care Administration.

 Six of those facilities were hospitals, 22 nursing homes, 37 assisted living facilities and 10 were “other” health care facilities, Knapp said, citing statistics that had been provided to the FHCA by the Agency for Health Care Administration (AHCA).

Florida Division of Emergency Management Director Kevin Guthrie did not on Wednesday morning have any final numbers regarding health care facility closures, but he said that most health care facilities that had evacuated had moved out their patients on Tuesday.

Florida Gov. Ron DeSantis, meanwhile, said that he talked to a handful of hospital CEOs on Wednesday morning, including some that had closed due to the storm. According to the Governor’s schedule, he met with Tampa General Hospital CEO John Couris, HCA West Florida Divisional President Jyrick Sims and Advent Health West Florida CEO David Ottadi.

Agency for Health Care Administration (AHCA) Deputy Secretary for Health Care Policy and Oversight, Kimberly Smoak, praised the work done so far by health care providers while on a statewide phone call with the nursing home industry.

Smoak asked that nursing homes make sure that their facilities that evacuated did not sustain any damage before they bring back residents.  Smoak asked the industry to stay in touch with state officials and to update their power status and availability of generators.

“As it gets hot in the state, all eyes are on us,” Smoak said.

The day before the storm hit Florida State Chief Meteorologist Amy Godsey held a statewide phone call with the nursing home industry and warned them that the storm could be as bad as recent hurricanes. “It’s going to be a pretty bumpy ride,” she said.

“Think Hurricane Ian,” she continued, referencing the 2022 Category 4 Hurricane that made landfall in southwest Florida leaving $112 billion in damage, making it the costliest hurricane in Florida’s history. “We’re about in the same situation if you want to draw comparisons.”

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— Safety first —

As part of the effort to respond to Hurricane Idalia the Department of Health helped support 45 special needs shelters in numerous counties and staked 33 strike teams, totaling nearly 200 ambulances, to help with facility evacuations and patient transport needs.

AHCA staff, meanwhile, made more than 1,111 calls on Tuesday in a coordinated outreach effort to all residential health care providers in the cone of the hurricane, along the coastlines, in mandatory evacuation zones.

State officials also reported this week that 100% of operating long-term care facilities had a generator on-site.

— Q&A with Mary Mayhew —

As Hurricane Idalia barrels toward the state, Florida Hospital Association President and CEO Mary Mayhew agreed to talk to Diagnosis Tuesday about the lessons learned from past hurricanes and what Florida hospitals are doing to prepare for the impending storm. Below is an edited version of that interview.

Q: Were hospitals given enough time to prepare for this storm?

Hospitals want to ensure that you have access 24/7 before, during and after a storm. Hospitals are required to have an emergency management plan. And a huge focus of that is hardening their facilities to withstand the strength of the hurricane-force winds, and to evaluate any flooding vulnerabilities and to mitigate against the flooding. And after every hurricane, they’re learning and they’re constantly updating. So, hospitals have installed wells on their campuses. As you know, that was one of the biggest challenges in southwest Florida. It wasn’t the hospital’s physical plant; it was at this municipal water system shut down. You have hospitals that have built flood walls. They put in flood doors; they’ve erected permanent barriers. And so, each hospital, depending on where they’re located, in terms of the path of the storm, looks at the risk of surge from flooding, and the strength of their facility, plant, their physical plant. They’re evaluating all that and they are consulting with local emergency management officials. That’s step one, and we have to remember that if it’s safe and quality (is) maintained in the hospital, that’s far less disruptive than moving and transporting hundreds, if not thousands of patients to other facilities in the state. Especially when we know and have experienced situations when storm tracks changed and went in the direction of where patients had been transferred to.

Q: Are hospitals going to have enough staff to work on this?

We’ve got the most recent experience with Hurricane Ian. And this is such a core part of their drilling and their preparation. Staff are divided into A and B teams; they are clear about which team is on-site first and then they’re relieved by the second team. And obviously, depending upon the impact and the duration of some of the challenges, that is all coordinated. What can be problematic is when those communication systems are disrupted. For example, Lee Health was talking about the importance of using local radio stations to broadcast information to staff about which team should be reporting to the hospitals, and when, in order to preserve that 24/7 access. You know, again, based on the recent experience with Hurricane Ian, but I’m certain you can talk to a variety of hospitals over the years with some of the other hurricanes, you know, they’re dealing with such a need for response to those who are injured in the storm and others with serious illnesses that come to the hospital during the storm, you want to try and fundamentally preserve that access (rather) than moving patients.

Q: Other than the greater Tampa area, the trajectory of this storm appears to be targeting smaller rural areas in the state. Are there added challenges for rural hospitals and if so, why?

Regardless of size, every hospital must have that emergency management plan that must be reviewed and approved by local county emergency management officials. But often, what we find with our rural hospitals, is that they may not have had access to the resources to make some of the investments to strengthen and harden their facilities. We also have some facilities that are still recovering from Hurricane Michael, because of the impact and the trajectory of that storm. We’ve been working, as you may recall, to help support increased capital investment funds for our rural hospitals that the legislators actually authorized. This past session is just a perfect example of why those capital improvement funds that the Legislature has had on the books but had not been funded for years are so important because you want to preserve that access. What you will often hear from some of the larger hospitals in the surrounding areas, while they partner very closely with rural hospitals, (is) they can’t absorb all of the capacity of those rural hospitals. So, we need to have transfer arrangements established in the event that a hospital needs to evacuate, but also be making critical investments in the physical plants for those rural hospitals.

Q: So how much were you able to secure this Session for that?

$10 million non-recurring.

Q: It’s great for those facilities that got funding, but have they been able to reap the benefits of it yet?

No, not yet. So, it just underscores the value of those dollars that, certainly over the next couple of years, will continue to help support that hardening and strengthening of our rural hospitals. But certainly, our rural hospitals are evaluating based upon the trajectory of the storm, whether they can keep their patients safe and their facilities are strong enough, or they are making the decision to evacuate, and that’s been occurring over the last 72 hours.

— Food, but what about health care? —

The Department of Children and Families (DCF) announced it will release SNAP (Supplemental Nutrition Assistance Program) September benefits early for residents impacted by Hurricane Idalia.

DCF did not comment whether it was stopping the Medicaid redetermination process in those same counties.

Typically, SNAP benefits would be added to EBT cards Sept. 1 -15.

“We know how helpful the early release of food assistance benefits can be for our SNAP recipients in purchasing non-perishable items in preparing for the storm or in replenishing food losses after the storm,” Secretary Shevaun Harris said. “If you are in the path of this storm, it is important to finalize your preparations. The department will do all that it can to support those impacted by this storm.”

DCF has authorized early release for residents in Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Osceola, Orange, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia and Wakulla counties.

DCF did not immediately respond to Florida Politics’ inquiry regarding whether it would put the redetermination process on hold due to Hurricane Idalia. Before the storm, public interest groups had asked the state to pause its redetermination process and ultimately sued the DeSantis administration in federal court alleging the state’s process violated people’s due rights.

— RULES —

—AHCA proposes developing Rule 59G-4.072, regarding Medicaid durable medical equipment and medical supply services. More here.

— AHCA proposes developing Rule 59G-4.073 regarding Medicaid durable medical equipment and medical supply services for orthotic and prosthetic. More here.

— AHCA proposes developing Rule 59G-4.074 regarding Medicaid durable medical equipment and medical supply services for respiratory coverage. More here.

— AHCA proposes developing Rule 59G-4.075 regarding Medicaid durable medical equipment and medical supply services for wheelchairs, hospital beds and ambulatory aids. More here.

— AHCA proposes developing Rule 59G-4.076 regarding Medicaid durable medical equipment and medical supply services for continence, ostomy and wound care coverage. More here.

— AHCA proposes developing Rule 59G-4.077 regarding Medicaid durable medical equipment and medical supply services coverage policy for enteral and parenteral nutrition. More here.

— AHCA proposes amending Rule 9G-4.150 to incorporate by reference the Medicaid inpatient hospital services coverage policy. More here.

— AHCA proposes amending Rule 59G-4.190 to incorporate by reference the Medicaid laboratory services coverage policy. More here.

— The Board of Hearing Aids Specialists proposes Rule 64B6-8.003, incorporating two updated DOH forms regarding training programs for hearing aid specialists. The changes to the forms are necessary to clarify that the program only applies to prescription hearing aids and does not apply to over-the-counter hearing aids. More here.

— LOBBYISTS —

Lizbeth Benacquisto, AGL Solutions: Shell Point Retirement Community

Jim Campolongo: Novavax

Bryan Cherry, PinPoint Results: Charis Healthcare Holdings

Travis Cummings, Oak Strategies: HCA Healthcare

Amanda Fraser, Katie Webb, Colodny Fass: Digital Diagnostics

Daniel Leyte-Vidal: Florida Department of Health

— ETC —

— The Office of Insurance Regulation (OIR) is reminding insurers, managed care plans and other entities of their obligations to fill prescriptions early following Executive Order 23-171, which declared a state of emergency in Alachua, Bay, Calhoun, Charlotte, Citrus, Columbia, DeSoto, Dixie, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Pasco, Pinellas, Polk, Sarasota, Sumter, Suwannee, Taylor and Wakulla counties. Specific to Medicaid, the state announced several changes because of the storm. Effective Sept. 28, all prior authorization requirements for critical Medicaid services were waived, as were policy limits for crucial services until further notice. Medicaid has also postponed all preadmission screening and resident review (PASRR) Requirements until further notice.

— CFO Patronis announced that the state’s eight Urban Search and Rescue (US&R) teams are stationed within their communities to respond after the storm. Additionally, six federal teams based out of Virginia, Pennsylvania, Missouri, Texas and Tennessee are being deployed to Florida. There will be approximately 700 US&R personnel in the state, said Patronis, who also is the state’s chief fire marshal.

— AHCA has activated the Emergency Patient Look-Up System (E-PLUS). Special needs shelters can utilize the system to retrieve patient medical records. E-PLUS can also assist medical providers and emergency response personnel in locating missing or displaced persons after the storm. DOH inputs the shelter registration information into E-PLUS as special needs shelters begin opening.

— Uber announced it would offer free round-trip rides, up to $35 each way, to and from state-approved evacuation centers in five Florida counties expected to be impacted by Idalia: Hernando, Hillsborough, Leon, Manatee and Pinellas. To order a free Uber, open the app and tap “Account” on the bottom right. Then, tap “Wallet” and scroll down to “Add Promo Code.” Enter code IDALIA RELIEF. From there, select any state-approved Florida evacuation shelters listed at https://www.floridadisaster.org/planprepare/shelters.

— The Agency for Persons with Disabilities (APD) has mapped the locations and current census of APD clients it serves in potentially affected areas and has been holding daily calls with the Arc of Florida, the Florida Association of Rehabilitation Facilities, the Florida Developmental Disabilities Council, waiver support coordinator associations, and representatives from the Family Care Council. APD also asks those entities to provide data related to their census, staffing, site readiness, and any emerging situations or unmet needs in the community. APD also visited Tacachale, a state institution located in Gainesville, to support the team and ensure facility readiness.

— The Florida Policy Institute has published a guide to the safety net resources that could potentially be mobilized by federal, state, and local government agencies to provide relief to Floridians impacted by the storm. More here.

— And in non-hurricane related news: The Long-Term Care Ombudsman Council meets Sept. 7. Additionally, the Florida Supreme Court will hear oral arguments Sept. 8 in Planned Parenthood of Southwest and Central Florida, et al. v. State of Florida, a case challenging a law (HB 5) banning abortion after 15 weeks of pregnancy. If the court rules that the 15-week ban can remain in effect, a six-week ban signed into law by the Governor earlier this year will take effect. For information on the long-term care meeting, call (850) 414-2323 or email [email protected] for a copy of the agenda.

— ROSTER —

— Steve Harris was promoted to senior vice president of payor and government affairs of Tampa General Hospital, the facility announced this week.

— Tony Lee, M.D., FACC, a cardiologist with Baptist Heart & Vascular Institute (BHVI), has earned board certification from the American Board of Clinical Lipidology.

— ICYMI —

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

Rate drop: The National Council of Compensation Insurance (NCCI) is proposing insurance carriers reduce their workers’ compensation costs on average by 15% for Florida businesses starting Jan. 1, 2024. Statewide business associations cheered the news. “This is good news for the otherwise inflationary pressures small-business owners are feeling,” NFIB Florida Executive Director Bill Herrle said, adding that recent NFIB polling showed that 21% of business owners reported that inflation was their single most important problem in operating their business.

Non-non-compete: Navarre physician and Rep. Joel Rudman doesn’t generally support President Joe Biden’s policies. But Rudman, like Biden, wants to ban noncompete clauses. While Biden wants to ban noncompete clauses for all workers, Rudman only wants to ban them in health care contracts — and only for medical doctors and osteopathic doctors. To that end, Rudman filed HB 11 this week. The two-page bill amends state statutes to make clear that covenants that prohibit physicians from practicing medicine within a geographic area for any period after the termination of a contract, partnership, employment or professional relationship are “not supported by a legitimate business interest” and therefore are “void and unenforceable.”

— FOR YOUR RADAR —

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

“Florida fined an Orlando abortion clinic $193K. Its volunteers are crowdfunding the bill” via Caroline Catherman of the Orlando Sentinel — Less than two weeks after Florida fined a local abortion clinic $193,000 for breaking state law, the clinic’s volunteer escorts have crowdfunded two-thirds of the bill. As of Thursday, over 4,000 people had donated more than $150,000 to a Givebutter fundraiser organized on behalf of the Center of Orlando for Women on Lucerne Terrace. The fundraiser was created by Stand with Abortion Now (SWAN), a grassroots volunteer organization that escorts patients past protesters and into the clinic. The state Agency for Health Care Administration fined the center for violating a Florida law that requires women to wait 24 hours after their first clinic visit to get an abortion. The law was passed in 2015 but was tied up in court until a Leon County Circuit judge upheld it in April 2022.

“Next generation of COVID-19 vaccines and therapies gets a $1.4 billion boost” via Jennifer Shutt of Florida Phoenix — The Biden administration on Tuesday announced a $1.4 billion investment in developing the so-called next generation of COVID-19 vaccines and treatments. Health and Human Services Secretary Xavier Becerra and Assistant Secretary for Preparedness and Response Dawn O’Connell announced that the funding is part of the $5 billion program they hope will help the country get ahead of any changes in COVID-19. “This is an investment in expanding our country’s ability to respond to the future variants that we might see coming out of COVID,” Becerra said. “It’s an investment in better protecting all of our community, including those who are immunocompromised, and who don’t respond well to the existing vaccines.”

— PENCIL IT IN —

Saturday

Happy birthday to Rep. Spencer Roach.

Monday

Happy Labor Day.

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