Diagnosis for 9.21.23: 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.

— All eyes on APD —

House Speaker-designate Daniel Perez has overall goals and personal goals. While the former is making homeowners insurance more affordable and available, the latter is improving community-based care delivery for people with intellectual and developmental disabilities who receive help from the Agency for Persons with Disabilities.

“There are priorities of Danny Perez, the individual. And then there are the priorities of Danny Perez, the elected official who represents the district you’re talking about. Danny Perez, personally, just as you know, the kid who grew up in Miami, I will tell you, ‘Yes, absolutely.’ Personally, this is huge to me,” Perez told Florida Politics.

On Monday, Perez shared the story of his younger brother, who has a severe developmental disability. Perez knows that not everyone with a developmental or intellectual disability is “blessed” to have Brian’s familial support.

“I saw that firsthand,” Perez said, adding he didn’t want to “get too into the weeds on that.”

“This is about the people that don’t have, you know, the ability to have family around them that love them, and care for them and to give them what they need, which is tough. And it’s tough on the family that’s providing that help. But that’s personal to me.”

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— The beginning of what’s next —

Florida has a Medicaid waiver that allows the state to provide home and community-based services to people with intellectual and developmental disabilities in the community and outside of institutions.

According to budget documents, the program, called iBudget, serves more than 35,500 people. There are another 21,800 individuals on the waiting list.

People with intellectual and developmental disabilities are some of the only residents eligible to receive care from the state’s safety net programs outside the managed care delivery system.

With Perez’s influence, lawmakers passed a Medicaid managed care “pilot project” this year to evaluate whether home and community-based and traditional health care services can be integrated into a managed care model for people with developmental disabilities. Lawmakers agreed to allow up to 600 people on the iBudget waiting list to participate in the pilot program.

Perez said he’s been speaking with APD Director Taylor Hatch, who is on board with the plan to integrate home and community-based services with traditional health care services in a managed care network.

“It’s a new model; I think we’re starting to move from the fee-for-service model to more of a managed care model. If we see that that works in Miami Dade, and we can roll it out to the entire state …. Honestly, if you’re telling me in three years, I’m on my way out, and we were able to completely delete the people that were on the iBudget waitlist and provide them a complete set of services, health care services, I would tell you that I think I served my time as Speaker well. That, to me, would probably be one of my greatest accomplishments, if not my greatest accomplishment,” Perez said.

“So, I think the pilot program is the beginning of what is next. Because if the pilot program doesn’t work, then we have to go back to the drawing board,” he said. “But this is our first attempt to chip away at that wave. And so, we’ll see how it works out.”

— Opening the wallet —

The Agency for Health Care Administration (AHCA), meanwhile, is requesting the federal government to endorse the pilot program approved for Medicaid Regions D and I.

And while it isn’t yet operational, AHCA wastes no time looking to expand it.

AHCA legislative budget request for fiscal year 2024-25 includes $29 million to the pilot program which is meant to keep people living in the community and outside of institutions.

The LBR does not indicate that the funds would be used to expand the pilot beyond the original two areas approved by the Florida Legislature.

LBRs are not official budgets. They are wish lists agencies provide the Legislature ahead of the Legislative Session. They are also provided to the Governor for consideration as he prepares his budget recommendation.

Meanwhile, the pilot program isn’t the only move toward managed care for people with intellectual and developmental disabilities. According to the Medicaid ITN, AHCA will assign people with intellectual and developmental disabilities to Medicaid managed care plans. They will get an opportunity to opt-out after the fact.

— Scope wars? —

The House and Senate are poised to take a closer look at the health care workforce during the 2024 Session and what can be done to help alleviate worker shortages.

To that end, House Speaker Paul Renner created a Select Committee to examine the issue.

Those familiar with the discussions say lawmakers don’t want to bring “scope of practice” into the debate. Scope of practice generally refers to what health care professionals can do within their license.

It’s common for professionals to try and expand the services they can provide under their state license, and their attempts often result in a battle.

In Florida, there have been scope of practice battles between optometrists and ophthalmologists regarding eye care. Physicians and certified registered nurse anesthetists (CRNAs) have long battled over anesthesia care.

With the blessing of the Florida Medical Association, the Legislature approved what are known as certified anesthesiology assistants (CAA). CAAs don’t have the same autonomy CRNAs enjoy, but both require physician supervision.

While the Legislature may try to avoid the scope of practice battle, the Florida Board of Medicine will enter the ring during its Oct. 6 meeting in Dania Beach.

Members of the BOM, which physicians dominate, have agreed to consider a petition for a declaratory statement from Nyree Penn, founder & CEO of ROSOMNIA Sleep, an organization dedicated to pioneering advancements in clinical sleep therapy. She is also a CAA.

“This petition seeks to bring parity to the professional landscape … ensuring CAAs enjoy indirect supervision and prescriptive rights comparable to those of our professional mid-level, counterparts, Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs),” she wrote in the petition.

Penn says that the training CAAs, PAs and CRNAs receive is comparable.

But Michelle Canale, president of the Florida Association of Nurse Anesthesiology, disagrees.

“Rest assured, the Florida Association of Nurse Anesthesiology (FANA) is closely monitoring this development and is filing a factual statement in opposition to these filings,” she said in correspondence to FANA members that was later posted on social media.

— Expensive branding —

“Strong Florida Moms.”

That’s the name the Department of Health (DOH) wants to spend more than $450,000 to brand.

In its LBR for FY 2024-25, DOH is asking for $456,200 to develop a website that touts the state’s existing maternal and child health programs under the Strong Florida Moms moniker.

According to the budget narrative, the umbrella name will incorporate Florida’s Healthy Start Program, Florida Healthy Babies, Levels of Maternal Care, Fetal and Infant Mortality Reviews, and the Maternal Health Outcomes Telehealth Pilot.

“While (DOH) implements programs and initiatives promoting healthy pregnancy and birth outcomes, they are not branded or easily identifiable, limiting accessibility and use by mothers and families in Florida,” the LBR reads.

— Sick doctor —

A Florida administrative judge recommends that state authorities revoke the medical license of a Central Florida doctor who pleaded no contest to criminal charges of video voyeurism, including one that revolved around setting a spy camera in the bedroom of his girlfriend’s 13-year-old daughter.

Court records show that the Board of Medicine acted against Dr. Ajay Kumar Doddapaneni in early 2022. Still, Doddapaneni, a radiologist, disputed the complaint, and the case eventually went before an administrative judge in May 2023.

An attorney for Doddapaneni contended that he should be able to keep his medical license because the criminal cases he pleaded no contest to had nothing to do with his medical practice.

His lawyer also claimed that Doddapaneni had set up the camera in the 13-year-old’s bedroom because he was trying to see if she was doing drugs. It was also suggested that Doddapaneni agreed to plead no contest to avoid lengthy incarceration and be able to continue to provide support for his family.

Administrative Judge Elizabeth McArthur, however, sided with state regulators in a ruling issued Wednesday.

McArthur wrote in her order that the “respondent’s extremely poor judgment, invasion of privacy of a 13-year-old child (and an adult), and his dishonest, evasive demeanor on display at the hearing, denying to this day that he did anything wrong as opposed to simply making an isolated ‘mistake,’ are all deeply troubling.”

— RULES —

— AHCA proposes amending Rules 59A-36.019 and 59A-36.025 regarding emergency environmental control for assisted living facilities. More here.

— The Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling proposes amending Rule 64B4-3.0035 to clarify the education necessary before licensure. More here.

— The Board of Nursing proposes amending Rule 64B9-3.0025 to update the clinical non-stimulation requirement and remedial courses for reexamination. More here.

— LOBBYISTS —

Michael Corcoran, Jacqueline Corcoran, Matt Blair, Samantha Sexton Greer, Bethany McAlister, Will Rodriguez, Andrea Tovar, Corcoran Partners: A Door of Hope

Gangul Gabadage, Continental Strategy: GenCare Resources

Anna Higgins, Team 180 Consulting: Children’s Home Network

Nick Iarossi, Ron LaFace, Megan Fay, Scott Ross, Christopher Schoonover, Capital City Consulting: University of Miami

Ron Pierce, Melody Arnold, Edward Briggs, Natalie Brown, Natalie King, RSA Consulting: BayCare Health System

— ETC —

— AHCA received and accepted the following letters of intent for the Sept. 27, 2023, application filing date for the Hospice batching cycle: Flagler County (District: 4B), Arc Hospice of Florida — New Hospice program; and Seminole County (District: 7C) Arc Hospice of Florida — New hospice program. If requested within 14 days after notice that an application has been filed, a public hearing may be held at the local level within 21 days after Oct. 25, 2023, when the application is scheduled to be deemed complete.

— With rising revenues and decreased expenses, the North Broward Hospital District Board of Commissioners agreed to lower the tax millage rate, saving Broward County taxpayers $30 million. “We recognize the financial challenges so many of our residents are currently facing,” Shane Strum, president and CEO of Broward Health, said in a prepared statement. “Our community was there for us these past few challenging years, but now it’s Broward Health’s turn to return the favor and give back.”

— To help improve residents’ quality of life through increased financial security, Molina Healthcare of Florida this week donated $10,000 to Branches, a Miami-Dade nonprofit that provides free financial coaching. Studies Indicate that Floridians need advice. A national 2021 survey found that only 28% of Floridians have a high level of financial literacy. A more recent WalletHub survey found Miami has the second-highest amount of credit card debt of all Florida municipalities, with over $2.1 billion. “We are proud to support Branches, a leading community-based organization that is advancing financial literacy and helping hardworking families across the state achieve long-term stability and success,” said Mike Jones, plan President of Molina Healthcare of Florida. “We are committed to providing our neighbors with the tools they need to live happy, healthy and prosperous lives.” The donation is part of Molina’s recently announced MolinaCares for a Healthy Florida initiative that has committed more than $700,000 to improve Floridians’ overall health and well-being.

— ROSTER —

— Melody Bonomo was named the Market President for AmeriHealth Caritas Florida, a Medicaid managed care plan that serves seven Florida counties. Bonomo served as the director of plan operations and administration.

— Six Florida-based Chief Medical Officers were recognized in Becker’s Hospital Review list of 130 Hospital and Health System Chief Medical Officers to Know.

— Jerry Capote, CMO of the 409-bed Broward Health North in Deerfield Beach. He also continues to serve as CMO for Broward Health Imperial Point in Fort Lauderdale. He trained as a pulmonary critical care physician.

— Peggy Duggan, executive vice president and CMO of the 1,041-bed Tampa General Hospital. She previously served as the CMO for the Boston-based Brigham and Women’s Faulkner Hospital.

— Also, TGH recognized Asa Oxner as vice president and associate CMO. She specializes in internal medicine. Oxner came from USF Health, also based in Tampa.

— Timothy Groover, senior vice president and System CMO at Baptist Health Jacksonville. In 2014, Groover became the first Black physician elected to the board of directors of Baptist Health, the most extensive private health system in Jacksonville. Groover previously served as Chief of Staff of Baptist Medical Center Jacksonville, chief of the department of anesthesiology, medical board and executive committee chair.

—David Moorhead, executive vice president and Chief Clinical Officer of AdventHealth in Altamonte Springs. He previously served as Senior Vice President and CMO of Orlando-based Florida Hospital (now known as AdventHealth Orlando). Before that, he was CEO of Loma Linda (California) University Medical Center and helped create the Loma Linda University Children’s Hospital.

—George Ralls, M.D., Senior Vice President and CMO at Orlando Health. In addition to overseeing clinical care delivery and quality, Ralls provides leadership for the health system’s graduate medical education, organizational performance improvement, medical staff services and clinical research. He also has been credited as an essential asset to the organization’s COVID-19 response.

—ICYMI —

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

— PBM rules approved: Florida top officials swiftly approved new rules designed to crack down on pharmacy benefit managers (PBMs), a necessary step to conduct changes pushed by DeSantis.

— Homework assignment: Across the country and throughout Florida, too many young people live in crisis. In 2022, nearly 48% of Florida high school students and almost 47% of middle school students reported feeling “depressed or sad on most days.” This crisis requires a comprehensive response to ensure our young people have the resiliency skills they need and, when appropriate, access quality mental health and substance use treatment to get better. A critical first step is to ensure adults recognize the signs and symptoms of someone who needs help.

— Good move: More than 17,000 youths in and around the Big Bend area where Hurricane Idalia struck last month will enjoy fully paid-for health coverage through Halloween, according to the Florida Healthy Kids Corp. The state-created nonprofit administers the Florida KidCare umbrella health insurance program and agreed to pay 100% of eligible monthly premium payments for September. Because the payments are in advance, the children will keep coverage through October.

— Another good move: New maternity and family leave benefits announced Monday make Florida the state employer with the “most robust” paid leave policy for mothers who give birth — at least in the Southeast, officials say. Before this, state employees had no paid maternity or family leave specified for the birth or adoption of a child. Sick, vacation, or unpaid leave could be utilized in those events, but there was no specific paid leave.

— Fatherhood update: More than $83 million has been cleared for spending through 2026 to address what DeSantis has called a national “fatherhood crisis.” Of that, $5 million remains uncommitted and will fund programs in lesser-served areas of the state, said Jess Tharp, assistant secretary of community services for the Department of Children (DCF). The largest chunk, $26.6 million, is set aside for a pro-fatherhood ad and informational campaign by Family First, a Tampa nonprofit that will use part of the funding for technical assistance and to track the performance of other grant recipients.

—FOR YOUR RADAR —

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

“Florida law restricting transgender adult care can be enforced while challenged in court” via The Associated Press — A new Florida law restricting health care for transgender people can still be applied to adults while it is challenged in court, a federal judge ruled Monday. Judge Robert Hinkle, who previously blocked the law’s enforcement on behalf of minors, ruled that adults seeking to expand his injunction haven’t proven they would be irreparably harmed until the case is resolved. The law signed by DeSantis in May bans any transgender treatment for minors and requires transgender adults to consent to treatment in person and with a physician present.

“COVID-19 second opinion: Florida’s former top doc says DeSantis wrong to discourage boosters” via John Kennedy of USA Today Network — Florida’s former top public health official criticized DeSantis’ latest foray into COVID-19 vaccine skepticism, saying the state is wrong to discourage those under age 65 from getting the new booster. Dr. Scott Rivkees, who preceded Dr. Joseph Ladapo as the state’s surgeon general, said the move runs counter to public health goals. “Rates of COVID vaccination are lower in Florida than they had been,” said Rivkees, who resigned in September 2021 after being shunned by DeSantis for encouraging COVID-19 precautions. “I think the cumulative effect of this anti-vaccine messaging is being felt,” he said.

“DeSantis contradicts own abortion law to claim woman will not be criminalized” via Ed Pilkington of The Guardian — DeSantis has contradicted the wording of the six-week abortion ban that he signed into law in April, insisting that women who terminate their pregnancies will not be criminalized under the prohibition. DeSantis said women would not be liable for fines and imprisonment under the ban. Only doctors who perform abortions would be targeted. “We have no criminal penalty. The penalties are for the physician,” he said.

“Central Florida COVID-19 hospitalizations continue to rise as tests dwindle” via Caroline Catherman of the Orlando Sentinel — Though state leaders continue to downplay the virus’s risks, Florida currently has the highest COVID-19 hospitalization rate in the U.S., and tests to check for infections are getting scarce. 12 per 100,000 Florida residents are hospitalized with the virus. This is the 11th week in a row that the state’s COVID-19 hospitalizations have increased. Orange, Seminole, Volusia, Lake, Flagler and Sumter counties saw a total of 301 COVID-19 hospital admissions for the week ending on Sept. 2. That’s an 18% decrease from a week before but a 41% increase from a month ago. Osceola County, reported separately, saw 59 admissions, an increase of over 30% from a week prior.

“$6.3 million wake-up call: Judge finds former Duval jail medical provider liable for COVID-19 outbreak” via Nichole Manna of The Tributary — A state judge found Armor Correctional Health Services at fault for a 2020 COVID-19 outbreak that infected at least 197 inmates and staff at the Duval County jail. Fourth Judicial Circuit Judge Katie Dearing ordered Armor to pay more than $6.3 million in damages and attorney’s fees to two former Jacksonville Sheriff’s Office correctional officers and their wives after both men were hospitalized with the coronavirus. Armor managed the jail’s medical care after the Jacksonville Sheriff’s Office signed a contract with the company in Oct. 2017. The Sheriff’s Office dropped the contract and signed with a new company, NaphCare, after The Tributary reported that deaths in the jail tripled under Armor.

—PENCIL IT IN —

Thursday

9 a.m. — Jo Ann Jenkins, AARP CEO, Republican Sen. Bill Cassidy of Louisiana, and Democratic Congressman John Larson discuss Social Security. The event will be livestreamed on AARP Advocates Facebook and moderated by PBS Correspondent Lisa Desjardins. Following the event, volunteers from around the state will be available to speak to the media via Zoom. Meeting ID: 91214239534; passcode: 588453

10 a.m. — The State Consumer Health Information and Policy Advisory Council (SCHIP Advisory Council) ad hoc committee meets. 2727 Mahan Dr. Tallahassee 32308-5407. Virtual meeting link here. Agenda here. Background materials here.

Friday

Happy birthday to Sen. Jennifer Bradley and Rep. Michele K. Rayner-Goolsby.

8:30 a.m. — The Medicaid Pharmaceutical and Therapeutics Committee meets to make recommendations to the Medicaid preferred drug list. Zoom link here.

1:30 p.m. — AHCA hosts a public hearing on proposed amendments to Rule 59G-4.250 to incorporate by reference the Florida Medicaid prescribed drug services coverage. 2727 Mahan Dr., Bldg. 3, Tallahassee, 32308-5407.

2 p.m. — AHCA hosts a public meeting on proposed amendments to Rules 59G-4.072, 59G-4.073, 59G-4.074, 59G-4.075, 59G-4.076, 59G-4.077: 2727 Mahan Dr., Tallahassee, 32308-5407.

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