Diagnosis for 10.5.23: 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.

— The Sunburn 5 —

Diagnosis is taking Sunburn’s time slot this morning, so Christine Sexton’s unparalleled health care coverage deserves attention. Here’s a rundown of the top non-health-care happenings for you to peruse while Sunburn takes a day off.

—“Florida leaders don’t see Matt Gaetz’s quarrels in Washington causing trouble back home” via Jacob Ogles of Florida Politics — Gaetz, already a controversial figure, drew heavy fire from members of his party after leading the first successful ouster of a House Speaker in U.S. history. But in Florida’s 1st Congressional District, few offer harsh words for Gaetz. “My Congressman, Matt Gaetz, was brilliant yesterday,” said Sharon Regan, Santa Rosa County Republican Party Chair. Political observers see little vulnerability for Gaetz. He represents a district where nearly 66% of voters supported Republican Donald Trump in the 2020 Presidential Election. During his last time on the ballot, Gaetz performed better than that. That landslide came despite a sex scandal and federal investigation that thrust Gaetz into the national spotlight.

—“Could a Florida Republican emerge as the next U.S. House Speaker? And what about Donald Trump?” via Mitch Perry of the Florida Phoenix — In the aftermath of Kevin McCarthy’s ouster, several members of Congress have indicated they want Trump to serve as the next Speaker. That includes Sarasota Republican Greg Steube. However, Trump may not be eligible, even if he shows interest. Another Florida Republican whose name has been floated as a potential candidate is Southwest Florida U.S. Rep. Byron Donalds. Central Florida first-term Republican Congressman Cory Mills told Fox News that while he “certainly supports President Donald J. Trump,” he also thought Donalds would be a good pick. Republican Party of Florida Chair Christian Ziegler worked for years on Capitol Hill and said the decision on the next speaker will be based a lot on relationships. He says he’s all for Donalds getting into the competition.

—“What can Patrick McHenry, the Interim Speaker, do?” via Kayla Guo of The New York Times — McHenry, who is now serving in the role of speaker pro tempore — “for the time being” in Latin — is in uncharted territory. House staff aides believe the acting speaker may wield the gavel only to administer the election of a new Speaker. But others argue that as acting Speaker, McHenry can exercise powers beyond overseeing the Speaker’s race as long as a majority tolerates it. House rules do not explicitly prohibit the interim speaker from adopting the powers of an elected speaker. But the rule that led to McHenry’s ascent was developed with only temporary absences in mind, not a vacant chair, according to Stan Brand, the former General Counsel to the House.

—“Florida’s immigration crackdown is three months old. How’s that going?” via Juan Carlos Chavez of the Tampa Bay Times — Touted as the most effective and ambitious immigration measure in the nation by supporters, SB 1718 also came with its share of criticism when Gov. Ron DeSantis signed it into law earlier this year. Much of the backlash was aimed at a part of the law that imposed felony charges for transporting immigrants without legal status into Florida. How many people have been charged with the new crime three months after the law went into effect? So far, the total is three, according to records from the state’s Department of Highway Safety and Motor Vehicles. All three criminal cases were in August and involved two Mexican nationals and one Honduran. According to police records, one Hernando County trooper arrested two drivers, while the third was arrested in Sumter County.

—”Ron DeSantis’ money problems deepen ahead of a key stretch in the GOP Primary” via Jonathan Allen, Henry J. Gomez, Matt Dixon and Natasha Korecki of NBC News — The Florida Governor’s presidential campaign entered this month with just $5 million in cash available for the Primary, a sum that reignites doubts about his solvency, budgeting and ability to gain ground on front-running Trump. The pain is so acute that DeSantis is redeploying aides from his Tallahassee headquarters to Des Moines for the stretch run of a do-or-die Jan. 15 Iowa caucus. A better-funded operation might hire locally rather than shift resources. Past presidential campaigns have typically employed such a move only as a last-ditch cost-saving measure — and to look for a campaign-changing boost in an early state. “The cash crunch has accelerated in the past month. It’s a huge problem,” said one DeSantis donor.

— ‘Hostage’ —

U.S. Sen. Rick Scott is debuting a new ad for his re-election campaign during Sunday Night Football next week.

Backed by a five-figure media buy, the spot highlights the recent government funding debacle and blasts politicians who “attempted to hold American disaster victims hostage in exchange for sending more money to Ukraine.”

The ad notes that Senate Democrats blocked Scott’s Federal Disaster Responsibility Act because it did not include funding for Ukraine and intended to tie disaster relief money to Ukraine funding. Scott ultimately secured $16 billion for Floridians and other Americans recovering from natural disasters.

“The politicians who run Washington are destroying our country. When I asked the Senate to provide funding for Florida hurricane victims, the Democrats refused. They said they’ll only help Americans if we agree to send billions more to Ukraine,” Scott says in the ad, sporting his trademark Navy ball cap. “So, Washington politicians held American disaster victims hostage in exchange for sending more money overseas. It’s shameful, and it’s why we have high inflation and the biggest debt in history.”

The Scott campaign said the buy covers the Tampa, Fort Myers, Tallahassee and Gainesville markets.

In a news release announcing the ad, Scott said: “I’m in the Senate to represent the great state of Florida and that’s why I aggressively fought back when Washington politicians tried to hold Floridians hostage in exchange for funding foreign wars.

“While much more work still needs to be done on the budget process in Washington so we can finally deal with our $33 trillion in debt that has caused this rampant inflation, I am glad we were able to secure this critical funding for Florida. My new ad is a reminder to those in Washington that I won’t let them ever get away with playing politics with hurricane victims.”

The former two-term Governor and first-term GOP U.S. Senator is up for re-election next year. Though multiple Democrats are running, Scott’s likely General Election opponent is former U.S. Rep. Debbie Mucarsel-Powell.

To watch the ad, please click on the image below:

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

— RULES —

—’Illegal and immoral’ —

Florida Attorney General Ashley Moody is accusing one of the nation’s electronic cigarette makers of targeting its advertising to children to induce them to use vaping products that contain nicotine.

Moody’s office filed a lawsuit against Juul Labs Inc. in Hillsborough County on Wednesday. The action by Moody comes more than five months after Juul reached a $462 million settlement with six states and the District of Columbia and more than a year after the company agreed to pay nearly $444 million to settle a two-year investigation pushed by 33 other states.

Those payments followed similar allegations over how Juul marketed its vaping products, which critics have blamed for creating a surge in youth vaping.

“Exploiting our children and jeopardizing their health for financial gain is illegal and immoral. Juul cannot sweep its role in creating the teen vaping epidemic under the rug,” Moody said. “As Florida’s Attorney General and a mother, I will not allow Juul or any other vaping business, to violate the law and target our children with products that are addictive and particularly harmful to their still-developing minds and bodies.”

Moody’s lawsuit accuses Juul of violating Florida’s Deceptive and Unfair Trade Practices Act and asks for restitution and civil penalties as well as an injunction blocking the company from “targeting children through their marketing and product design, and from deceiving consumers with respect to nicotine concentration of their products.”

The lawsuit alleges that “Juul relentlessly marketed to underage users with launch parties,

advertisements using trendy-looking and young models, social media posts and free samples. It created a technology-focused, sleek design that could be easily concealed.

and sold its product in flavors known to be attractive to underage users.”

The company is also alleged to have “manipulated the chemical composition of its product to make the vapor less harsh on the throats of the young and inexperienced consumers it courted” and “to preserve its young customer base, Juul relied on age-verification techniques that it knew were ineffective.”

In late April, Juul said it had reached settlements with a total of 48 states and territories and had agreed to pay more than $1 billion to combat underage use and develop cessation programs. In August, the company reportedly slashed 30% of its workforce to cut costs and bolster profits ahead of anticipated litigation settlement payouts.

— Going down —

Homeowners insurance rates have been increasing in the Sunshine State, but there’s a line of insurance in Florida where rates have gone down for six consecutive years: workers’ compensation. And 2024 appears to be staying on trend.

How much of a reduction in the coming year remains to be seen. The National Council National Council of Compensation Insurance (NCCI) is proposing rates be reduced by an average of 15% for Florida businesses starting Jan. 1, 2024.

The Florida Office of Insurance Regulation (OIR) is holding a public hearing on the proposed reduction today at 2 p.m.

The proposed filing is based on data from policy years 2020 and 2021 as of year-end 2022. The industry has seen favorable loss experiences in each of those years. NCCI did note in its analysis a potential upward pressure on medical costs resulting from a recent state Division of Administrative Hearings final order. The proposed rate also takes into consideration changes in the medical fee schedule.

Workers’ compensation has produced some of the most heated legislative battles, but at least one business interest issue during the 2024 Session.

“I don’t anticipate workers’ compensation legislation in ’24,” NFIB Executive Bill Herrle said in August.

Register for the virtual meeting here. Or call (877) 309-2074, access code 501919816.

— Expanding statewide? —

The state Agency for Health Care Administration (AHCA) wants to take a housing assistance pilot program that operates in two Medicaid regions statewide.

The Florida Medicaid program operates a waiver program that helps adults (21 and older) who are homeless or at risk of homelessness and have a serious mental illness (SMI) or substance use disorder (SUD).

Members of the Medicaid Medical Care Advisory Committee (MCAC) Behavioral Health/Substance Use Subcommittee were told Wednesday that AHCA had been discussing the pilot, which currently operates in Medicaid Regions 5 and 7, which incorporates Pinellas and Pasco and Lake, Seminole, Orange Osceola and Brevard, respectively.

“Expansion statewide is something that the agency is looking into. And I believe actively working with the Legislature on and looking to see if that’s something that could be worked into appropriations,” said Tim Buehner, program administrator of the Medicaid behavioral health unit.

— Where’s Passidomo on Medicaid? —

Senate President Kathleen Passidomo has been spending the last few months working on a health care proposal called “Live Healthy.” (Her big affordable housing push was called “Live Local.”)

In an interview she gave back in July to Dara Kam with News Service of Florida, Passidomo flatly ruled out any talk of Medicaid expansion being part of that health care overhaul aimed to deal with the state’s looming shortage of nurses and doctors.

But this week, Rep. Joel Rudman, a conservative Republican and doctor who has been an ally of DeSantis on matters dealing with COVID-19, has said that GOP legislators should look at Medicaid expansion.

Katherine Betta, a representative for Passidomo, said this week that “the President does not plan to weigh in on Rep. Rudman’s legislation at this time.”

Rudman, who recently went on what he called a health care listening tour, said it was time to consider expansion because of the high cost of providing health care to the working poor who turn to emergency rooms because they don’t have health care coverage.

A coverage gap currently exists in Florida, where low-income adults earn too much for Medicaid but fall below the income requirements that would allow them to purchase a health care policy through the federal marketplace. Currently, 41 states and the District of Columbia have expanded Medicaid. North Carolina — which has a Democratic Governor and a Republican-controlled Legislature — plans to implement it at the end of the year.

— RULES —

The Board of Osteopathic Medicine proposes developing Rule 64B15-14.014 to replace the emergency rule setting forth the standards of practice for minors treated for gender-affirming care. More here.

The Board of Osteopathic Medicine proposes developing Rule 64B15-13.0142 to replace the emergency rule regarding mandatory informed consent for gender-affirming adult care. More here.

The Board of Medicine proposes developing Rule 64B8-9.019 to replace the emergency rule setting forth the standards of practice for minors treated for gender-affirming care. More here.

The Board of Medicine proposes developing Rule 64B8-9.0192 to replace the emergency rule setting forth the mandatory informed consent for sex-reassignment prescriptions or procedures in adults under section 456.52, F.S. More here.

The Board of Psychology proposes amending Rule 64B19-13.003 to update the requirements regarding continuing psychological education credit granted for service as the board’s continuing education liaison. More here.

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

The Board of Occupational Therapy proposes the development of Rule 64B11-2.011, which defines requirements for supervised fieldwork experience where no OT services exist. More here.

The Board of Occupational Therapy proposes developing proposed amendments to 64B11-5.001. More here.

— LOBBYISTS —

Brian Ballard, Mathew Forrest, Ballard Partners: Intellectually Developmentally Disabled Community Foundation

Chip Case, Jefferson Monroe Consulting: Park Place Behavioral Healthcare

John Fiore: Velocity BioGroup

Jonathan Rees, Smith Bryan & Myers: The Arc of Florida

— ETC —

— Tampa General Hospital President and CEO John Couris is rewriting the script on professional and mental support for physicians in the health industry. The strategy? To tackle burnout and mental health challenges and foster a safe working environment where physicians and team members can feel valued, respected and heard by leadership and colleagues. “At Tampa General, we deploy leading with love through a leadership model, AKTiVe, built on four qualities of leaders and leadership: authenticity, kindness, transparency and vulnerability,” Couris said. “When these qualities are embraced and enacted by leaders, it creates a more positive and psychologically safe environment for physicians, team members and patients.” Read more here.

— NAMI Florida is holding three online events for its Hispanic Heritage Month webinar series, NAMI Compartiendo Esperanza, sponsored by Molina Healthcare. NAMI Member Celia Morales will lead the webinars featuring mental health and wellness conversations in the Hispanic community and beyond. The second webinar in the series is set for 11:30 a.m. today. The third is scheduled for 11:30 a.m. on Oct. 12. Tune in via Zoom.

— An expedited certificate of need (CON) application for JDM Health Services, LLC received tentative approval this week. The 84-bed facility is proposed for Okaloosa County. The CON for the project is being transferred from Village Health Services. More here.

— ARC Hospice of Florida and Charis Healthcare Holdings have submitted applications for new hospice programs in Lake County, AHCA announced. Charis Healthcare Holdings also submitted CON applications for new hospice programs in Flagler and Seminole counties. ACHA also has published a calendar of tentative hearing dates. More here.

— Boca Raton-based vitaCare is laying off nine employees in early October but anticipates it may reduce its workforce by more than 50 employees. If so, that would be a 33% reduction in its workforce, according to a WARN notice filed with the state.

— The Tampa Bay Business Journal named Tampa General Hospital (TGH) a 2023 Tampa Bay Inno Award honoree. TGH is recognized in the Partnerships category for its innovative work with the Tampa Bay Economic Development Council (EDC) on developing a medical and research district.

— CareSource and Spark Pediatrics announced they have created ImagineCare, which will work with provider service networks (PSNs) that operate in Florida’s Medicaid managed care program. CareSource is a nationally recognized managed care organization and Spark Pediatrics provides prescribed pediatric extended centers (PPEC or Medical Daycare) in both Florida and nationally,

— John Knox Village in Orange City, Florida, has made Newsweek’s list of Top 10 Nursing Homes nationwide.

— ROSTER —

— Tara Ezzell, M.D., was appointed by the Governor to serve on the Gainesville Regional Utilities Authority.

— HCA Florida Aventura Hospital promoted Andrew Hiller, M.D., who has been named Department Chair of Surgery at HCA Florida Aventura Hospital.

—The Emergency Nurses Association elected Ryan Oglesby as the 2024 president-elect.

— ICYMI —

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

Sorry, kids: Democrats, alarmed at what they say is a startling number of children getting knocked out of Medicaid, are calling on the DeSantis administration to act now to stop more children from losing health care coverage. Democrats made their request just two days after DeSantis himself brushed aside questions about the state’s above-average rate for the uninsured at the second Republican presidential debate, calling Florida a “field of dreams.” But Democrats in the House released an analysis Friday that shows that of the 524,076 Floridians who have lost coverage in the last four months, nearly 50% — or 257,901 — are individuals aged 20 or younger.

No health insurance? No problem: DeSantis is deflecting questions about the more than 2.5 million residents who do not have health insurance. During the GOP Primary debate on Wednesday, DeSantis was asked by Stuart Varney of Fox Business about why the state has a higher uninsured rate than the nation overall. At first, DeSantis blamed inflation and economic policies enacted under Biden. He said that health care interests like pharmaceutical companies were “putting patients at the back of the bus.” When Varney pressed again, DeSantis said Florida was a “dynamic” and growing state but then defended the state’s existing safety net programs as helping keep Florida’s overall unemployment rate down.

A ‘Nixon goes to China’ moment: Rudman recently completed what he called his health care listening tour, where he held meetings in the Panhandle, Central and South Florida. Three themes emerged: high levels of uncompensated care, low Medicaid reimbursement rates and a workforce shortage. Rudman said the loss of Medicaid coverage for hundreds of thousands of Floridians this year illustrates the need for change. A spreadsheet compiled by House Democrats shows that of the 524,076 Floridians who have lost coverage in the last four months, nearly 50% are under 21. While people have lost their Medicaid coverage, Rudman says, they aren’t losing access to health care. “They’re costing us more money by showing up in the emergency room because they do not have access to a primary care physician.”

Compromise: Rep.Fabián Basabe thinks Florida’s current ban on abortion after 15 weeks and a since-passed ban after six weeks of pregnancy are wrong. He believes 12 weeks is the right limit, and he’s filed legislation to make that “compromise” law. Basabe says the measure (HB 93) will “rectify the limitations imposed by DeSantis’ previous policies.” In addition to doubling the time frame by which women can terminate pregnancies under the state’s so-called “Heartbeat Protection Act,” the measure prohibits physicians from performing abortions by telehealth through medication or medicine.

Pearly whites: Those who have served may get the chance to get free dental work done in November. That’s courtesy of Congressman Gus Bilirakis and the Pasco County Dental Association. They’re teaming up to host the annual “Stars, Stripes and Smiles” event again on Nov. 3, a week before the country celebrates its soldiers on Veterans Day. Bilirakis prioritizes veterans’ issues, including dental care, in Congress. He said in a statement that it’s unfortunate that dental care through the VA is limited to those who are 100% disabled or have a direct service-connected injury impacting their oral health. Bilirakis is working on expanding that coverage.

— FOR YOUR RADAR —

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

—“Fort Myers health care billing company faces data breach; notifies patients” via Liz Freeman of the Naples Daily News — A Fort Myers-based health care billing company faced a data breach that put patients’ personal data in jeopardy of unlawful use. According to a news release, Arietis Health LLC., with offices in Fort Myers, Durham, North Carolina and India, has notified patients of the data breach that occurred May 31 and was confirmed July 26 after an investigation. Arietis began notifying patients of the breach on Sept. 29 with offers of credit and identity monitoring services. Officials at the company could not be reached for information on how many patients have been impacted by the breach.

—“In Florida, Surgeon General ushers in a bright new day for medical quackery” via Diane Roberts of Florida Phoenix — The Quack (Joe) Ladapo doesn’t want you to get the new COVID-19 booster shot. It’s terrible, horrible, no good and very bad. It hasn’t been tested! Or if it has, specific secret clinical trials reveal it could kill you, turn you schizo or cause your extremities to fall off in the street, which is exactly what the CDC, the FDA, and Anthony Fauci, Doctor of Doom, want! No, he won’t show you the lab reports. You wouldn’t understand them unless you possess the peculiar genius of the Quack, DeSantis, or perhaps Tucker Carlson, who knows ferr shurr that Fauci engineered the virus to murder Americans and somehow make billions of dollars. So, no booster jab for you, fellow Floridian! Unless you’re over 65. Then you can get one.

—“DeSantis forced to say why he enjoys denying health insurance to poor Floridians” via Jonathan Chait of New York Magazine — The Republican Party is the only major conservative party in the world whose governing doctrine rejects higher taxes on absolute principle, refuses to acknowledge anthropogenic global warming, and denies that health insurance should be a right of all citizens. This last point surfaced during the second Republican presidential debate when DeSantis was asked to explain why his state ranks near the national bottom in health insurance coverage. Because these moments occur so rarely, it was highly revealing. He believed health insurance should be an earned benefit, not a right.

—“Pinellas equity advocates voice concerns on gentrification, homelessness” via Veronica Brezina of the St. Pete Catalyst — Limited access to job centers and stagnant incomes accompanied by escalating housing prices are pricing people out of their homes, leaving some without anywhere to turn to. This is an ongoing cycle that St. Pete’s economic and racial equity leaders are battling in the wake of the city’s inevitable growth. “We know optimal outcomes should be obtainable regardless of race, income or geography, but it’s not like that,” Foundation for a Healthy St. Pete CEO and President Kanika Tomalin said during The Leadership PSTA (Pinellas Suncoast Transit Authority) Summit held Tuesday morning inside St. Pete’s Center for Health Equity. Tomalin and PSTA planning manager Jacob Lubutka said both entities have come together to help educate the public about available resources and community offerings to help people land back on their feet. For example, PSTA offers an on-demand program for paratransit riders and has extended service to provide transportation for late-night workers. However, there are other efforts and programs taking shape that local equity advocates are deploying.

—“‘It’s the only thing he’s got left’: DeSantis’ rivals try to turn his Florida record against him” via Gary Fineout and Sally Goldenberg of POLITICO — DeSantis’ main pitch for months has been that his record of conservative governance — what he has called the “Florida Blueprint” — would inspire Republican voters. Now his GOP rivals are throwing it back in his face. During Wednesday’s debate, DeSantis frequently defended his record on education, spending, energy policy and access to health insurance — even if some of his opponent’s attacks weren’t entirely accurate. The sustained assault on his performance in Florida marks a new moment in DeSantis’ presidential campaign, as emboldened rivals like Nikki Haley and Chris Christie blast away at one of his last remaining pillars of political strength. “They see him bleeding out, and they’re trying to get those voters to come their way,” said Jason Cabel Roe, a national Republican consultant. “It’s the only thing he’s got left. If you’re with him, it’s because of his record.”

— PENCIL IT IN —

Thursday

10:30 a.m. — The Health Information Exchange Legal Work Group meets. AHCA 2727 Mahan Dr. Tallahassee or virtually here.

2 p.m. — The Florida Office of Insurance Regulation holds a rate hearing on the National Council effective Jan. 1, 2024. Register for the virtual meeting here. Or call (877) 309-2074, access code 501919816.

2 p.m. — Medicaid Medical Care Advisory Committee (MCAC) HIV/AIDS Subcommittee meeting. Microsoft Teams: Meeting ID: 246 164 672 276, Passcode: pWXDCE. For more information, contact Kissa Smith at [email protected].

Wednesday

9 a.m. — The Senate Appropriations Committee on Health and Human Services meets. AHCA, the Department of Children and Families and the Florida Healthy Kids Corporation will provide Medicaid redetermination updates. The committee also will hear an update on the expansion of income eligibility for the Florida KidCare Program. 412 Knott Office Building.

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