Diagnosis for 10.12.23: 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.

—“House recesses as Steve Scalise looks to secure Speakership votes” via The Hill — U.S. Rep. Scalise, a Louisiana Republican, came out on top as House Republicans met to pick their nominee for Speaker. The conference was closely divided between the House Majority Leader from Louisiana and House Judiciary Committee Chair Jim Jordan of Ohio. Indeed, the final vote was close — a win by 14 votes. But a messy floor fight may be ahead, with several Republicans already noncommittal about supporting Scalise. The House gaveled briefly after the conference vote, then recessed, presumably to allow him time to find enough votes to win the Speakership. Former Speaker Kevin McCarthy’s ouster last week was unprecedented, and the days since have featured curveball after curveball.

—“Benjamin Netanyahu forms emergency Israel government and war Cabinet” via Kathryn Armstrong and Yolande Knell of the BBC — Netanyahu and Benny Gantz have also agreed to form a “war management Cabinet” to deal with the conflict. The announcement comes after savage attacks by Hamas militants from the Gaza Strip. It sees both men put aside a bitter political rivalry that had escalated into widespread protests. Alongside Netanyahu and Gantz, the centrist National Unity Party leader and a former Defense Minister, the new temporary Cabinet would also include Defense Minister Yoav Gallant. The country’s main opposition leader, Yair Lapid, has not joined the alliance. However, Netanyahu and Gantz said in a joint statement that a seat would be reserved for him in the war Cabinet.

—“Republican lawmakers to introduce resolution to expel George Santos from Congress” via Ryan Nobles and Dareh Gregorian of NBC News — A group of House Republicans from New York are introducing a resolution to expel U.S. Rep. Santos, a New York Republican, from Congress. “Today, I’ll be introducing an expulsion resolution to rid the People’s House of fraudster George Santos,” U.S. Rep. Anthony D’Esposito said in a post on the social media platform X. He told reporters he considers Santos “a stain” on the House and New York state. “It’s time that we move on from George Santos,” D’Esposito said. He said the resolution will be co-sponsored by fellow New York House Republicans Nick LaLota, Mike Lawler, Marc Molinaro, Nick Langworthy and Brandon Williams.

—“Ron DeSantis dogged by Nick Fuentes questions during CNN interview” via A.G. Gancarski of Florida Politics — Gov. DeSantis spent some time on CNN struggling with questions about an anti-Israel White supremacist with ties to Donald Trump. After multiple redirections, DeSantis finally responded to what he called “garbled” comments from interviewer John Berman about Trump dining at Mar-a-Lago with Fuentes, who deemed Israel’s slow response to Hamas attacks over the weekend a “little suspicious” and beneficial to Netanyahu’s Likud Party. “I would not do that,” DeSantis said about dining with Fuentes. Before finally offering that tepid rebuke, DeSantis dodged questions, including one about how he feels about Republicans “associating” with Fuentes.

—“Lauren Book refiles bill to ban victim-blaming defense in gay or transgender ‘panic’ crimes” via Jesse Scheckner of Florida Politics — Senate Democratic Leader Book is again trying to pass legislation to prohibit defendants accused of violent crimes against homosexual and transgender people from blaming the victims for the defendants’ actions. The measure would ban legal defenses that cite nonviolent sexual advances or the belief that another person is gay or transgender in criminal court proceedings. Such a defense is known as the “gay/trans panic defense,” according to the American Bar Association, as it seeks to partially or fully excuse crimes like murder and battery if a victim’s sexual orientation or gender identity triggered a defendant’s violent action. Accordingly, the bill is titled the “Gay and Transgender Panic Legal Defense Prohibition Act.”

— Medicaid dental out to bid —

The state Agency for Health Care Administration dropped its second multiyear Medicaid ITN, the latest for the Statewide Medicaid Managed Dental Plan.

If all goes as planned, AHCA will sign new multiyear Medicaid dental contracts with at least two statewide dental companies by March 29, 2024.

Timelines are subject to change and often do.

But the initial timeline gives vendors until Jan. 4, 2024, to submit their responses to the state.

They will be officially open on the same day. Dentists and other oral health providers with experience with any respondents will have 10 days to submit comments to the state.

According to the timeline, AHCA anticipates negotiating with vendors between Feb. 5, 2024, and March 1, 2024.

Before that, AHCA gives vendors until Oct. 27 to submit questions about the lengthy ITN. The timeline anticipates AHCA responding on Nov. 17.

Florida requires all Medicaid patients to receive dental care through managed care plans. The state currently has three plans under contract: Dentaquest, LIBERTY and MCNA Dental.

This is the first re-procurement of the Medicaid dental program. It comes after a legislative battle over the delivery of dental care and whether it should be carved out from the traditional Medicaid managed care program.

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

— What’s what —

Included in the mammoth ITN are provisions that the managed dental plans must cover, but also what costs the plans are not required to cover.

According to the ITN, Medicaid managed dental plans won’t be responsible for any inpatient hospital facility fees associated with dental services; emergency dental services provided in a facility setting; outpatient prescription drugs prescribed by the dental provider for treatment of a dental condition; preventive dental services when rendered by a non-dental provider; and transportation to and from dental appointments.

The ITN clarifies that those services “are available to dental plan enrollees through the fee-for-service delivery system or through an MMA Plan.”

According to the ITN, the state can also assign medically complex children in the Florida KidCare program to the statewide managed dental program.

— The other Medicaid ITN —

Dental care was once included as part of the original Medicaid managed care programs for managed medical assistance and long-term care, which are also being procured.

As a refresher, after pushing the timeline back to answer additional questions, vendors must submit their response to the Medicaid ITN no later than Oct. 25 at noon.

ACHA will open the responses at 3 p.m. the same day. According to the timeline, AHCA anticipates posting the names of the vendors submitting answers on its website by Oct. 27.

AHCA plans on negotiating with vendors between Dec. 4, 2023, and Jan. 26, 2024. It intends to announce which plans it intends on inking contracts with on Feb. 23, 2024.

— FMA donates —

The Florida Medical Association has made some of its most significant donations for the 2024 cycle to the political committee boosting Senate Republicans, led by Senate President Kathleen Passidomo.

Campaign records filed this week show that the FMA donated $150,000 to the Florida Republican Senatorial Campaign Committee in August and September.

The donations come when Passidomo has been working on a significant health care proposal called “Live Healthy” that she expects to roll out sometime before the 2024 Session.

During the 2023 Session, Passidomo championed a bill that would have prevented optometrists from calling themselves “physicians” — a new chapter in the long-running “Eyeball Wars” saga in the Capitol that has been waged between optometrists and ophthalmologists.

But Gov. Ron DeSantis vetoed the bill. And although DeSantis did not explain his decision, it was an action that the Florida Optometric Association hailed.

— Other health care donors —

Other health care organizations and companies also donated to FRSCC during the past quarter.

Trulieve, the medical marijuana company pushing an initiative that would allow recreational marijuana, gave $50,000. At the same time, the Florida Hospital Association’s political committee chipped in $65,000, the Florida Dental Association’s political committee gave $30,000 and Centene Management Company donated $25,000.

The political committee representing optometrists donated to Republicans but not to the GOP Senate campaign arm. Records show that OD-Eyepac donated $50,000 to the Republican Party of Florida in August.

— Donations to support abortion rights —

The group pushing to get an abortion rights amendment on the 2024 ballot said this week that it had raised over $10 million from more than 3,600 supporters as of Oct. 10.

Campaign finance records filed Tuesday with the Division of Election show that Floridians Protecting Freedom had raised more than $8.9 million by the end of September, meaning it has collected another $1 million in just the past 10 days.

“These incredible accomplishments are a testament to the tireless efforts of our fundraising team and a growing network of volunteers — from students to seniors — who have never wavered in their commitment to our campaign to put these deeply personal decisions back into the hands of patients and their health care providers, where they belong,” said Campaign Director Lauren Brenzel.

The organization — heavily funded by groups such as Planned Parenthood and the American Civil Liberties Union of Florida — is seeking an amendment before voters that would override existing abortion restrictions in the state. If passed in 2024, the Legislature would not be allowed to restrict abortion before fetal viability, which generally occurs around the 24th week of pregnancy.

Organizers must get close to 900,000 signatures to qualify for the ballot. So far, state election officials have verified more than 400,000. The amendment also needs to be reviewed by the Florida Supreme Court. Attorney General Ashley Moody has already said she plans to ask the court to reject the amendment as misleading.

— RULES —

— AHCA proposes amending Rule 59G-13.081 to incorporate by reference the Developmental Disabilities Individual Budgeting Waiver Services Provider Rate Table. More here.

— AHCA is proposing to amend Rule 59G-4.127 to incorporate by reference the Florida Assertive Community Treatment Services Coverage Policy. More here.

— The Board of Optometry proposes amending Rule 64B13-2.009 to update that telephone conference calls utilized to conduct other business involving the Board will not be compensated. More here.

— The Board of Opticianry proposes developing an amendment to Rule 64B12-15.001 regarding medical error courses and when opticians need to take the course. More here.

— The Board of Opticianry proposes amending Rule 64B12-15.008 regarding continuing professional education credit for videocassette courses taken by the licensee. More here.

— The Board of Opticianry proposes amending Rule 64B12-9.0015 regarding completing a two-hour laws and rules course by the Board-approved laws and rules course provider is no longer required for the Board to certify an applicant for licensure. More here.

— LOBBYISTS —

Kristen Allen, Larry Coggins: Mothers Against Drunk Driving

Brian Ballard, Jose Diaz, Katherine San Pedro, Ballard Partners: Banyan Health Systems

Taylor Biehl, Capitol Alliance Group: Lighthouse Vision Loss Education Center, Manasota Lighthouse for The Blind

David Childs, Kyle Langan, Andrew Liebert, Chad Revis, Eileen Stuart, The Vogel Group: Susan B. Anthony Pro-Life America

Gangul Gabadage, Continental Strategy: Chrysalis Health, Home Care Association of Florida

Jon Johnson, Johnson & Blanton: Florida Chapter American College of Cardiology

Dina Mayne Justice: Arc of Florida

Paul Mitchell, The Southern Group: Eastern Medical

Gerard O’Rourke, Elnatan Rudolph, Converge Public Strategies: Florida Chiropractic Society, Florida Veterinary Medical Association

Darren Patz, DLA Piper U.S.: Acorn Health, Blue Sprig Pediatrics, InBloom Autism Services

Mattie Velasco, Open Forum Strategy: Pillar Health Systems

Jileah Wilder, Becker & Poliakoff: Agape Community Health Center, Broward Community & Family Health Center, Foundation for Sickle Cell Disease Research

Victoria Zepp, Team 180 Consulting: Children’s Home Network

— ETC —

— The Florida Health Care Association released an analysis of proposed new nursing home staffing requirements that shows the new standards would cost Florida nursing centers an additional $188 million. The analysis was conducted by CliftonLarsenAllen (CLA). The Centers for Medicare and Medicaid Services proposes a rule requiring 2.45 nurse aide hours per resident per day and 0.55 registered nurse hours per resident per day. Under the CMS proposal, Florida centers must hire 3,487 full-time employees to comply with the mandate. That’s because Florida requires nursing homes to provide two certified nursing assistant hours per resident per day, 0.6 hours of direct care (which does not need to be provided by a certified nurse), and one hour of licensed nursing services provided by a combined use of registered nurses (RNs) and licensed practical nurses (LPNs). “Florida is a proud leader when it comes to high-quality long-term care. We recognize the importance of minimum staffing requirements, which is why Florida nursing centers already abide by a stringent set of standards to ensure residents receive the highest quality of care,” FHCA CEO Emmett Reed said. “At a time when Florida’s long-term care profession is facing workforce shortage challenges, these arbitrary and unfunded mandates will make it harder to recruit, train and retain long-term care workers.”

— University of Florida researchers have discovered that iron plays another critical role: It regulates the immune system, especially in the intestine. More here.

— SEIU member nurses and community allies rallied at Miami Circle to demand better staffing, pay and workplace protections, all of which, they say, will improve patient care. Organizers expected more than 300 SEIU member nurses from Florida, California, Colorado and Illinois to attend the Wednesday afternoon rally at the intersection of Brickell Avenue and SE 4th Street in Miami.

— ROSTER —

— AARP Florida recognized Sen. Colleen Burton as a 2023 Capitol Caregiver in honor of her work supporting older Floridians and caregivers across the state. Her work includes advancing policies that serve Florida’s older adults, expanding access to health care resources and supporting caregivers.

— Ascension named Michael Shaw its Chief Strategy Officer for Florida and the Gulf Coast.

— ICYMI —

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

Press pause: Health care advocacy groups continue to call on DeSantis to put the brakes on Florida’s Medicaid redetermination process and reinstate children disenrolled from the health care safety net program due to procedural reasons. DeSantis received a letter Tuesday signed by 50 organizations requesting the Governor to take a closer look at the state’s unwinding process and to streamline it to make it easier for people to re-enroll in the safety net program for the poor, elderly and disabled. The advocacy groups have also called on the DeSantis administration to take advantage of increased federal flexibilities offered by the Biden administration.

It’s official: Attorney General Moody is making good on her promise to ask the Florida Supreme Court to block a proposed abortion rights amendment from making the 2024 ballot. Moody officially requested the high court to review the initiative more than a month after the Department of State said the citizen initiative had cleared the threshold needed to reach the court. In her submission to the court, Moody did not explain why she wanted the court to block the measure, saying that she would present legal briefs later that explain why “the aforementioned initiative does not satisfy the legal requirements for ballot placement.”

Gas station heroin: A sprawling investigation into stores across the state resulted in the seizure of 653 packages of so-called “gas station heroin,” along with 1,272 packages of a synthetic cannabinoid. Agriculture Commissioner Wilton Simpson announced the outcome of a sweep conducted by authorities at the Florida Department of Agriculture and Consumer Services (FDACS). The multiday investigation of more than 50 businesses in 27 Florida counties yielded hundreds of packages containing the Tianeptine products, known as “gas station heroin,” according to an FDACS news release. Authorities also picked up or issued stop-sale orders for products containing THC-O, a synthetic, controlled cannabinoid.

— FOR YOUR RADAR —

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

—“Florida settles COVID-19 public records lawsuit, will begin releasing data again” via Jeffrey Schweers of the Orlando Sentinel — After a two-year court battle over the DeSantis administration’s refusal to produce COVID-19-related public records during the height of the pandemic, the state will begin rereleasing specific data for the next three years and pay all legal fees. Under the agreement, the Florida Department of Health will pay $152,250 to former Orlando state Rep. Carlos Guillermo Smith’s legal fees and cover its costs. It also will have to post detailed COVID-19 data on its website for the next 36 months. “The DeSantis administration has repeatedly tried to weaken the state’s public records law, hide information from the public, and they have finally been held accountable,” said Smith.

—“Florida kicked 63,000 people off Medicaid during the pandemic, report shows” via Christopher O’Donnell of the Tampa Bay Times — Even as Florida accepted billions of federal dollars to keep people enrolled in Medicaid during the pandemic, the state terminated medical coverage for almost 63,000 residents. The “continuous coverage” protection for Medicaid recipients was implemented through the Families First Coronavirus Response Act, passed in March 2020 as COVID-19 cases began spreading nationwide. States received billions of dollars in additional funding in exchange for keeping people covered through the health insurance program. But over 18 months through June 2021, Florida removed tens of thousands of people from Medicaid rolls, the audit by the Department of Health and Human Services found. The state accepted $2.4 billion in additional funding over the same period.

—“DeSantis health agency defying judge to block trans care, plaintiffs say” via Romy Ellenbogen of the Tampa Bay Times — In a motion filed Wednesday in the Northern District of Florida, the plaintiffs say the state’s Agency for Health Care Administration is in “complete defiance” of U.S. District Judge Robert Hinkle’s June ruling, which said the state’s Medicaid ban was “invalid” to the extent that it categorically banned Medicaid payment for treatments of gender dysphoria. They are asking Hinkle to enforce or clarify his ruling. They point to instances where transgender Medicaid recipients were denied coverage for hormone therapy after the June ruling and comments from the agency’s secretary warning of possible further action against Medicaid providers for violating the state’s rule.

—“USF receives $24 million for innovative dementia research” via Mark Parker of the St. Pete Catalyst — Researchers at the University of South Florida St. Petersburg have received a five-year, $24 million grant from the National Institutes of Health (NIH) to expand its groundbreaking dementia prevention research. Alzheimer’s disease, colloquially known as “the long goodbye,” is the most common form of dementia and affects over 5 million Americans. While there is no cure, USF researchers hope to prove computerized brain training can mitigate its effects. The funding supports the new Active Mind clinical research study, and local researchers need volunteers over the age of 65 and with some cognitive decline to participate. Dr. Jennifer O’Brien, associate professor of psychology and principal investigator on the St. Petersburg campus, said preliminary results are encouraging. Active Mind volunteers will complete at least 40 hours of computerized exercises over the two-year study. They receive a free iPad and can participate at the St. Pete or Tampa campus.

—“Sex education classes often don’t include LGBTQ+ students. New restrictions could make it worse” via The Associated Press — Many LGBTQ+ students say they have not felt represented in sex education classes. They often have had to look elsewhere to learn about their identities and how to build healthy, safe relationships. As lawmakers in some states limit teaching about sex and gender, it will be much more difficult for those students to come by inclusive material in classrooms. Some groups, including Planned Parenthood, have called for sex education to include LGBTQ+ students, but some states outright forbid such an approach. In practice, LGBTQ+ students say they have looked elsewhere for sex education. Some described watching their peers turn to pornography, and others said they watched videos on YouTube about telling if someone is gay and how to flirt with people of the same sex.

— PENCIL IT IN —

Thursday

Happy birthday to Sens. Lauren Book and Shevrin Jones.

Sunday

Happy birthday to Rep. Josie Tomkow.

Monday

2 p.m. — The House Select Committee on Health Innovation meets. AHCA will brief the committee on its efforts to implement 2023 legislation, including Medicaid coverage of continuous glucose monitors, the Florida KidCare Program expansion, and a pilot program for Individuals with developmental disabilities. The panel will also be updated on a 2020 law requiring hospitals to conduct patient safety culture and Medicaid managed care procurements.

Wednesday

It’s Behavioral Health Day at the Capitol.

9 a.m. — The Governor’s Panel on Excellence in Long-Term Care will be meeting to review applications received for consideration for the Gold Seal Award. Other business as needed may also be discussed. Call (888) 585-9008; participant code: 998518088. Email [email protected] for a copy of the agenda.

10:30 a.m. — Florida Behavioral Health Association and other advocacy partners from around the state will gather on the back steps of the Historic Florida Capitol for a news conference.

___

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