Diagnosis for 10.19.23: 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.

— Behavioral Health —

Wednesday marked Behavioral Health Day at the Florida Capitol, and at least one Democratic Senator is trying to build the case to expand Medicaid to young adults, especially those who have unmet mental health needs.

A bill filed by Sen. Lori Berman would direct the Agency for Health Care Administration (AHCA), in consultation with the 20-member Commission on Mental Health and Substance Use Disorder, to conduct a study to assess the potential impacts of expanding Medicaid to adults aged 18 to 26 to address some of the state’s unmet mental health needs.

Berman has long been a proponent of Medicaid expansion for all childless uninsured adults in Florida who qualify under Obamacare. She told Florida Politics that the bill reflects recommendations from the Marjory Stoneman Douglas High School Public Safety Commission and that she still supports an expansion under the federal health care law, saying she would “love to see Florida join the 40 other states in expanding Medicaid, but anything we do is obviously a benefit,” she said.

Berman’s bill would require the study to examine the correlation between unaddressed behavioral and physical health needs of young adults affected by the health insurance coverage gap and their use of urgent care and emergency room services compared to peers with health insurance coverage. AHCA also must recommend whether the Medicaid program can sustain an expansion of income eligibility criteria for such young adults and, if so, the changes that should be made to the income eligibility criteria.

According to a Kaiser Family Foundation analysis of U.S. Census Bureau data, 32.3% of adults in Florida reported symptoms of anxiety and/or depressive disorder this year between Feb. 1 and Feb. 13. That puts Florida on par with the national average, according to the Kaiser Family Foundation.

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— 3 Questions —

The Florida Behavioral Health Association joined forces with the Florida Association of Managing Entities, FCBH; the Florida Mental Health Advocacy Coalition, the Florida Juvenile Justice Association, the Mental Health Association of Central Florida, the Mental Health America of Southeast Florida, the Florida Initiative for Suicide Prevention, the National Alliance on Mental Illness-Florida, the American Foundation for Suicide Prevention, and Floridians for Recovery in recognition of Behavioral Health Day at the Florida Capitol.

FBHA President and CEO Melanie Brown-Woofter discussed the Association’s goals for the day and the upcoming 2024 Session.

Q: What would you like people to take away from the Capitol on Behavioral Health Day?

Brown-Woofter: We provide behavioral health as a grassroots effort to keep Behavioral Health at the forefront and to talk a drumbeat to ensure that people understand — especially legislators and funders — the importance of mental health and substance use disorder services and resources in the community, the importance that we have facing highest demand all-time high demand for services. And we face challenges with the workforce and with funding for resources. Last year, we had the most incredible year for funding that we have seen in decades, if ever, and we are thankful for that. And it has already had an immediate impact; it will impact generations to come. And at the same time, we need to be able to continue that level of funding because every dollar matters.

Q: Speaking of funding, there are mental health funding requests in some of the legislative budget requests. Can you talk to me about some of these?

Brown-Woofter: We certainly support the increase in mobile response teams, MRTs and 988 services. We have seen the mobile response team have demonstrated an ability to divert from a Baker Act situation. I believe the statistic is there’s 39 MRTS. Right now, they handle 28,000 calls and 82% of those were diverted from the Baker Act. That’s the latest statistics that we have. So, we see the MRT is very effective. And cost-effective. So, we see the need for additional funding for additional teams and to fund the team at a rate that covers the costs.

Q: I wonder if there’s a misunderstanding of mental health services available for uninsured residents. Are there services for the uninsured?

Brown-Woofter: Those services are available through the managing entity and through the community providers. People think that they have to either have a copay or pay part of the cost of the service. If they go to the community behavioral health center, they don’t realize that the fees can be waived, depending on their income. So, absolutely, those services are available.

— ICFDD beds in Hillsborough? —

There could be as many as 24 new beds at institutions for people with developmental disabilities in Hillsborough County.

Sunrise Community submitted letters of intent (LOI) notifying state health care planners they’d like to transfer as many as 24 beds from a 120-bed institution in Miami-Dade County and open six new four-bed centers in Tampa.

A letter of intent is not binding. However, it is the first step in the “certificate of need” licensure process required for new nursing home beds and ICFDDs, an acronym for institutions for people with developmental disabilities, in Florida.

There were two LOI for new nursing homes in Brevard County, one submitted by Brevard Operations to a new 90-bed community nursing home, the other submitted by HSP East Florida, also to establish a new 90-bed facility.

Letters of intent were also submitted to add new nursing home beds in Osceola, Martin, Okeechobee and Palm Beach counties. Mercy Center OPCO submitted an LOI to transfer five existing beds from North Dade Nursing and Rehabilitation. More here.

— Fast-tracking implementation —

Attorney General Ashley Moody is implementing “medical conscience” protections passed by the Legislature and championed by Gov. Ron DeSantis.

Lawmakers during the 2023 Session passed a measure to protect physicians’ free speech rights. The law also included a heavily debated provision that stated that any “health care provider or health care payer has the right to opt out of participation in or payment for any health care service on the basis of a conscience-based objection.”

The measure allows someone to file a complaint with Moody’s office and the Attorney General can commence a civil action against someone accused of violating the new law.

The Attorney General filed a notice this week saying her office has drawn up a new complaint form and that the rule implementing the new form will take effect Oct. 30.

The proposed form is three pages long and asks the complainant to answer a series of questions about the discrimination action and what steps were taken in response to the objection.

— Bills of interest —

Fall is here, legislative budget requests are in, and the 2024 Session is just around the corner. Here is a review of some of the bills filed as of Oct. 18 that we will be tracking:

HOUSE:

HB 11 by Rep. Joel Rudman — Invalid Restrictive Covenants with Physicians: Provides restrictive covenants prohibiting physicians from practicing medicine within a specified area for a certain period are void and unenforceable. Effective Date: July 1, 2024.

HB 35 by Rudman — Acceptance of Cash Payments by Businesses: Requires certain businesses to accept cash payments for certain transactions; prohibits fees or conditions for such transactions; provides applicability and civil penalties; requires DACS to adopt rules. Effective date: July 1, 2024.

HB 43 by Rep. David Silvers — Medicaid Behavioral Health Provider Performance: Revises provider network requirements for behavioral health providers in the Medicaid program; specifies network testing requirements; requires AHCA to establish specific performance measures; requires managed care plan contract amendments by a specified date; requires the agency to submit an annual report to Legislature. Effective Date: July 1, 2024.

HB 63 by Rep. Marie Woodson — Protection from Surgical Smoke: Requiring hospitals and ambulatory surgical centers to adopt and implement policies requiring the use of smoke evacuation systems during certain surgical procedures. Effective Date: July 1, 2024.

HB 65 by Rep. Rita Harris — Anaphylaxis in Public Schools: Requiring the Department of Education to publish on its website each district school board’s anaphylaxis policy; requiring each district school board to adopt an anaphylaxis policy; requiring a certain percentage of specified school personnel to receive certain training within a specified time frame, etc. Effective Date: 07/01/2024.

HB 77 by Rep. Spencer Roach — Recovery of Damages in Claims for Medical Negligence: Removes a provision that prohibits parents of an adult child from recovering certain damages in medical negligence suits. Effective Date: 07/01/2024.

HB 89 by Rep. Rachel Plakon — Naloxone Awareness Day: Designates June 6 of each year as “Naloxone Awareness Day”; authorizes Governor to issue annual proclamation; encourages DOH to hold events to raise awareness of dangers of opioid overdose & availability & safe use of naloxone as an effective way to reverse effects of opioid overdose rapidly. Effective date: Upon becoming law.

HB 147 by Rudman — Financial Assistance for Mental Health Professionals: Establishes mental health profession scholarship and loan forgiveness program within DOH for specified purposes and provides requirements for DOH, applicants, award of scholarships, loan forgiveness, & program recipients. Effective Date: 7/1/2024.

HB 159 by Rep. Gallop Franklin — HIV Infection Prevention Drugs: Authorizes licensed pharmacists to screen for HIV exposure and order and dispense HIV infection prevention drugs in accordance with written supervisory protocol or statewide drug therapy protocol; requires Board of Pharmacy, in consultation with the Board of Medicine and Board of Osteopathic Medicine, to adopt rules and develop statewide drug therapy protocol. Effective Date: 7/1/2024.

HB 161 by Rep. Dan Daley — Payments for Health Care Providers and Surgical Procedures under Workers’ Compensation: Payments for Health Care Providers and Surgical Procedures under Workers’ Compensation; increases maximum amounts of specific witness fees related to workers’ compensation cases; increases maximum reimbursements for physicians & surgical procedures under workers’ compensation.

SENATE:

SB 52 by Sen. Linda Stewart — Anaphylaxis in Public Schools: Requiring the Department of Education to publish on its website each district school board’s anaphylaxis policy; requiring each district school board to adopt an anaphylaxis policy; requiring a certain percentage of specified school personnel to receive certain training within a specified time frame, etc. Effective Date: 7/1/2024.

SB 56 by Sen. Gayle Harrell — Coverage for Skin Cancer Screenings: Requiring health insurance policies; group, blanket and franchise health insurance policies; and health maintenance contracts, respectively, to provide coverage and payment for annual skin cancer screenings performed by a licensed dermatologist without imposing any cost-sharing requirement; specifying a requirement for and a restriction on payments for such screenings, etc. Effective Date: 07/01/2024

SB 66 by Sen. Jason Brodeur — Naloxone Awareness Day: Citing this act as “Victoria’s Law”; designating June 6 of each year as “Naloxone Awareness Day”; authorizing the Governor to issue an annual proclamation; encouraging the Department of Health to hold events to raise awareness of the dangers of opioid overdose and the availability and safe use of naloxone as an effective way to rapidly reverse the effects of opioid overdose, etc. Effective Date: Upon becoming a law.

SB 100 by Sen. Shevrin Jones — Pregnant Women in Custody: Citing this act as “Ava’s Law” requiring that, upon her request, every female arrested and not released on bond within 72 hours after arrest be administered a pregnancy test within a specified time frame; requiring each municipal detention facility or county detention facility to notify each arrested female upon booking at the facility of her right to request a pregnancy test; authorizing a sentencing court to stay the beginning of the period of incarceration for up to a certain amount of time for a pregnant woman convicted of any offense; authorizing a judge to impose specific sanctions for another criminal conviction or a violation of the terms and conditions ordered by the judge, etc. Effective Date: 7/1/2024.

SB 106 by Jones — Acceptance of Cash Payments by Businesses: Requiring certain businesses to accept cash payments for certain transactions; prohibiting such companies from charging a fee or placing conditions on acceptance of such cash payments; providing penalties for violations of the act, etc. Effective Date: 7/1/2024.

SB 132 by Berman — Coverage for Diagnostic and Supplemental Breast Examinations: Prohibiting the state group insurance program from imposing any enrollee cost-sharing liability with respect to coverage for diagnostic breast examinations and supplemental breast examinations; prohibiting the imposition of cost-sharing requirements for diagnostic and supplemental breast examinations by individual accident and health insurance policies; group, blanket, and franchise accident or health insurance policies, etc. Effective Date: 7/1/2024.

SB 140 by Berman — Medicaid Eligibility for Young Adults: Requiring the Agency for Health Care Administration, in consultation with the Commission on Mental Health and Substance Use Disorder, to conduct a study for a specified purpose; providing the duties of the agency upon completion of the study; requiring the agency to submit a report of its findings and recommendations to the Governor and the Legislature by a specified date, etc. Effective Date: Upon becoming a law.

SB 152: by Berman — Caregiving Youth: Defining the terms “caregiving youth” and “household member”; creating the Florida Caregiving Youth Task Force within the Department of Health for a specified purpose; requiring the Department of Education to maintain and make available to school districts a comprehensive list of specified information; requiring each middle and high school to have a designated caregiving youth liaison; exempting caregiving youth from payment of certain tuition and fees under certain circumstances, etc. Effective Date: Upon becoming a law.

SB 164 by Sen. Tina Polsky — Solutions for Mental Health Professional Shortages: Establishing a mental health profession scholarship and loan forgiveness program within the Department of Health for a specified purpose; providing for applicant eligibility and the award of scholarships; identifying service obligations for scholarship recipients; providing for applicant eligibility and the award of loan repayments, etc. Effective Date: 7/1/2024.

SB 166: by Polsky — Protections for Public Employees Who Use Medical Marijuana as Qualified Patients: Prohibiting a public employer from taking adverse personnel action against an employee or a job applicant who is a qualified patient for their use of medical marijuana; providing exceptions; requiring a public employer to provide written notice of an employee’s or a job applicant’s right to explain or contest a positive marijuana test result within a specified time frame; providing procedures that apply when an employee or a job applicant tests positive for marijuana, etc. Effective Date: Upon becoming a law.

SB 186 by Brodeur — Progressive Supranuclear Palsy and Other Neurodegenerative Diseases Policy Workgroup: Citing this act as the “Justo R. Cortes Progressive Supranuclear Palsy Act” requiring the Secretary of Health Care Administration, in conjunction with the State Surgeon General, to establish a progressive supranuclear palsy and other neurodegenerative diseases policy work group, etc. Effective Date: 7/1/2024.

SB 208: by Sen. Danny Burgess — Alzheimer’s Disease and Related Dementia Training for Law Enforcement Officers: Requiring the Department of Law Enforcement to establish an online, continued employment training component relating to Alzheimer’s disease and related forms of dementia; requiring that the training component be developed with the Department of Elderly Affairs; authorizing the completion of such training to count toward a certain requirement, etc. Effective date: 7/1/2024.

SB 210: by Burgess — Mental Health Professionals: Reclassifying intern registrations as associate licenses for the professions of clinical social work, marriage and family therapy and mental health counseling; deleting the requirement that a licensed mental health professional be present on the premises when associate licensees, formerly classified as registered interns, are providing clinical services. Effective date: 7/1/2024.

—RULES —

—The Board of Opticianry proposes amending Rule 64B12-11.017 regarding duplicate licensure fees. More here.

—The Board of Physical Therapy Practice proposes amending Rule 64B17-5.001, requirements for reactivating an inactive or retired license. More here.

—The Board of Physical Therapy Practice proposes Rule 64B17-7.0029 regarding terms of probation. More here.

—The Board of Physical Therapy Practice proposes Rule 64B17-9.001 to update and clarify continuing education requirements. More here.

—LOBBYISTS —

Kaitlyn Bailey, Matthew Herndon, RSA Consulting Group: BayCare Health System

Gangul Gabadage, Continental Strategy: Florida Association of Health Plans, Florida Chiropractic Physician Association, Florida Optometric Association

Tanya Jackson, PinPoint Results: Dade Institute of Technology and Health

Anna Lewis, Metz Husband & Daughton: Curaleaf Florida

Darren Patz, DLA Piper U.S.: AQUA Dermatology, Orthopedic Care Partners Management

Sean Pittman, Pittman Law Group: Bond Community Health Center

Jeff Sharkey, Capitol Alliance Group: Manasota Lighthouse for The Blind

Christopher Snow, Snow Strategies: Children’s Rehab, Pediatric Medical Daycare of Ft. Lauderdale

Monte Stevens, The Southern Group: Eastern Medical

— ETC —

—Tampa General Hospital (TGH) announced a partnership with the Central Florida Behavioral Health Network (CFBHN) to treat Floridians suffering from opioid use in Hillsborough County. Through a mobile unit program, IDEA (Infectious Disease Elimination Act) Exchange Tampa, Tampa General and CFBHN offer a broad array of low-barrier health care services for those affected by opioid use disorder in the local community. This program is the first of its kind in the region.

—Researchers at the Comprehensive Cancer Center at the University of Miami Miller School of Medicine have been awarded a grant to study the impact of exercise and intermittent fasting on side effects from cancer treatment. Tracy Crane, Ph.D., RDN, and Carmen Calfa, M.D., have been awarded a $4 million, five-year grant from the National Cancer Institute to fund the research.

— Stephen D. Nimer, M.D., director of Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, has been named Researcher of the Year by BioFlorida, an association for the state’s life sciences industry. The award recognizes distinguished researchers whose achievements have significantly advanced scientific knowledge, impacting innovation and public health. It was presented to Nimer at the association’s annual conference this month.

—ROSTER —

— The Florida Association of Nurse Anesthesiology (FANA) announced its 2023-2024 President and leadership team. President: Karla Maldonado, DrAP, CRNA, APRN; President-elect: Laura Molina, DNP, CRNA; Secretary-Treasurer: Jorge Valdes, DNP, CRNA, FAANA; Vice President: Gregory Buck, CRNA; Immediate Past President: Michelle Canale, DNP, CRNA, APRN, FAANA.

— ICYMI —

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

Slow crawl: A legislative-mandated push to determine if health care professionals in Florida trust the hospitals where they work has yet to be put in place three years after it was ordered. Lawmakers in 2020 passed a bill requiring hospitals and ambulatory surgical centers to survey their staff members about their workplaces and report the information to the state. But the information won’t be available until sometime in 2026. That’s because the DeSantis administration has been slow to implement the rules necessary to make it happen. And Monday, a top health care regulator put the blame, in part, on the public health emergency associated with the COVID-19 pandemic.

Jailbird blues: Just 17% of Florida prisoners who need help with substance use disorders have access to treatment. Sixty-four percent need general education services, but only 4% are enrolled. According to a new report from the Florida Policy Project, prisoners who don’t receive the programming they need pose the highest recidivism risk. The elder inmate-focused report offers several takeaways. Among them: About 29% of Florida’s inmates are 50 and older, a rate notably higher than the national rate, and it costs roughly twice as much to care for them as their younger counterparts. Prisons with the highest percentages of aging inmates spend five times more on average per inmate in medical care and 14 times more on prescription drugs than institutions with the lowest percentage.

Press pause: Health care advocacy groups continue to call on DeSantis to put the brakes on Florida’s Medicaid redetermination process and to reinstate children disenrolled from the health care safety net program due to procedural reasons. DeSantis received a letter last week 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 Joe Biden administration.

— FOR YOUR RADAR —

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

“PrEP, a key HIV prevention tool, isn’t reaching Black women” via Sam Whitehead of KFF Health News — PrEP is a crucial tool in the fight against the ongoing HIV epidemic and, when taken as prescribed, is highly effective at preventing infection from sexual contact or injection drug use. But more than a decade after the first PrEP drug was approved for the U.S. market, one of the groups that would benefit most from the medications isn’t taking them: Black women whose gender identity align with their sex assigned at birth. Doctors, public health researchers, and those who provide HIV treatment and prevention services say long-standing, systemic factors, such as stigma and racism, are significant barriers to PrEP uptake among cisgender Black women. Transgender Black women also face obstacles to PrEP uptake, especially discrimination related to their gender identity.

“New power player in abortion politics: Yelp” via Tessa Stuart of Rolling Stone — Shortly after the Supreme Court’s Dobbs decision in the summer of 2022, Yelp began adding disclaimers on the pages for crisis pregnancy centers on its platform. In February, Kentucky AG Daniel Cameron — now the GOP nominee for Governor in the state — sent a letter signed by 23 other attorneys general (including Ken Paxton of Texas) accusing Yelp of a “scheme to discredit crisis pregnancy centers and to discourage women and families from accessing their services.” Sternly worded letters like these have become an increasingly common tactic among ultra-conservative AGs. Upon receiving the letter from Cameron, Yelp agreed to make the notice more specific. Its notice initially said CPCs “typically provide limited medical services and may not have licensed medical professionals on-site.” But it refused to take the notice down.

“Medicare enrollment is open now. Here’s what you need to know” via Donna Winchester of the Tampa Bay Times — Projected Medicare Advantage enrollment in 2024 will represent approximately 50% of all people enrolled in Medicare, compared to 48% for 2023. In Florida, the nearly 5 million individuals enrolled in Medicare, a slight increase from last year, will have 613 Medicare Advantage plans from which to choose. Floridians’ average monthly Medicare Advantage plan premium will be $10.38, up from $9.59 in 2023. Every Floridian eligible for Medicare can access a Medicare Advantage plan with a $0 monthly premium. Through the CMS Innovation Center’s Value-Based Insurance Design Model, 199 plans will offer additional options to Medicare Advantage enrollees throughout the state who receive low-income subsidies and those who are chronically ill, such as eliminated Medicare Part D cost-sharing; rewards and incentives programs related to healthy behavior; and customized benefits that address social determinants of health, such as food insecurity and social isolation.

“The big mistakes people make in Medicare — and how to avoid them” via Anna Wilde Mathews of The Wall Street Journal — Advertisements for Medicare Advantage plans especially may promise rich bonus benefits such as dental and vision coverage or even help to pay for food, as well as generous financial terms. But consumer advocates said seniors should be mindful of the downsides. Here are five of the biggest pitfalls for those going through Medicare open enrollment this fall — and how to avoid them.

— PENCIL IT IN —

Thursday

9 a.m. — The Office of Economic and Demographic Research will conduct a public workshop on the amendment to limit government interference with abortion. Room 117, Knott Building.

11 a.m. — The House Health & Human Services Committee has a panel discussion on hospital models in Florida. Room 214, House Office Building.

Sunday

Happy birthday to Sen. Jim Boyd.

Wednesday

9 a.m. — Cabinet meeting. The Capitol.

3 p.m. — The Physician Workforce Advisory Council meets. Meeting link: FLHealth.gov/PWACmeeting. Or call (850)-792-1375; participant code: 377945496#. A copy of the agenda may be obtained by contacting Jon Conley at (850) 617-1439 or online at FLHealth.gov/PWACmeeting.

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