Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— How soon is now? —
Momentum may be building to alter Florida’s medical malpractice laws in the upcoming Session.
Sen. Clay Yarborough, Chair of the Senate Judiciary Committee, has filed legislation that is closely similar to a proposal by Rep. Spencer Roach that would alter who is allowed to sue medical professionals and medical facilities in the event of a wrongful death.
Roach tried last year to pass what he has called the “free kill” bill, but while the legislation easily cleared the House, it did not go anywhere in the Senate. Now, he has a powerful ally who could help shepherd the legislation to the finish line.
When asked what this means for his proposal, Roach said in a text message, “fingers crossed.” Florida has for decades prohibited certain relatives from pursuing wrongful death lawsuits based on their age and connection to the person who died due to medical negligence. The law was pushed in response to concerns about increasing medical malpractice costs.
The new legislation (SB 248) would allow lawsuits from the adult children and the parents of an adult child who died if state regulators or the Department of Health concluded that the practitioner violated laws and rules that resulted in a death.
In the past, the medical community has been able to block proposed changes to medical malpractice laws, especially when Florida’s trial attorneys were pushing them. But one longtime health care lobbyist told Diagnosis that getting the Legislature to do it again may be a tough sell.
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— Public v. private —
There wasn’t a lengthy discussion, but a few choice comments at a recent legislative Committee meeting raised a few eyebrows.
Two Republican House members — including Rep. Randy Fine, the Chair of the House and Human Services Committee — questioned top officials of the groups representing Florida hospitals about why there needs to be public or government-owned hospitals instead of private not-for-profit or for-profit hospitals.
The main answer from Justin Senior, CEO of the Safety Net Hospital Alliance of Florida, was that local communities had made decisions about providing health care. He noted, for example, that Tampa General Hospital moved from public to private not-for-profit and that officials in Lee County were studying whether to make a similar transition.
The back-and-forth on the issue was brief, although at one point, Rep. Adam Anderson, a Republican from Palm Harbor, said he had a “different opinion” on whether public hospitals should be providing “broad health care services.”
The questions from Fine and Anderson didn’t lead to any declarations of legislative intent, but usually, legislative committees ahead of a Session are dedicated to specific topics and questions for a reason. They can often serve as the springboard or the prelude to legislative action that suddenly springs forward amid the tumult of a Regular Session.
Of course, the debate over the status of hospitals is a subject that has been discussed previously. Former Gov. Rick Scott, the CEO of one of the nation’s largest for-profit hospital chains before he was forced out amid a federal probe, created an entire commission in 2015 to study health care and hospital funding. That commission was created at the same time there had been a contentious legislative debate over Medicaid expansion.
There’s also been constant tension between some of the for-profit hospitals and the public hospitals over funding formulas in the state budget. The question is: Will there be another flare-up in the 2024 Session?
— Providers respond —
Now that entities have responded to the statewide Medicaid managed care ITN AHCA input from health care providers.
To that end, AHCA announced on Oct. 19 that it seeks comments from providers with experience with the responding vendors. On Oct. 19, AHCA published a notice directing providers to ITN.
Health care providers with experience with any respondents have until 5 p.m. advising Nov. 9 to submit their comments to the state.
Though AHCA officially opened the ITN response Wednesday, it does not anticipate posting the names of the vendors until Friday.
— Eleven years —
Enrollment in the federal Health Insurance Marketplace begins Wednesday and runs through Jan. 15.
According to the federal government, residents in 96% of the state’s 67 counties have access to three or more qualified health plans.
Florida has 14 qualified health plans offering Marketplace health coverage, according to the Centers for Medicare and Medicaid Services, which is one less plan than last year.
Starting Nov. 1, consumers can log in to HealthCare.gov and CuidadoDeSalud.gov or call (800) 318-2596 to complete an application and enroll in a 2024 Marketplace plan. Consumers who register by midnight on Dec. 15 will have a full year of coverage that begins on Jan. 1, 2024.
Because Jan. 15 is a federal holiday, people who miss the deadline will have until Jan. 16 to enroll in the Marketplace, but their coverage won’t be in effect until Feb. 1, 2024.
Covering Florida is available for those who would like assistance. It is Florida’s lead “navigator,” or the top entity working with the federal government to facilitate Marketplace enrollment.
— Career Climb —
In recognition of National Physical Therapy Month, the Florida Health Care Association is awarding Career Climb Scholarships to two St. Petersburg College students.
Krista Nolan and Theo Danet work at Menorah Life, a nonprofit senior living community providing skilled nursing care, rehabilitation, assisted living and adult day care in St. Petersburg. Nolan is a physical therapist assistant and Danet is a rehab tech.
“With October being National Physical Therapy Month, we are proud to recognize and invest in two professionals who commit to improving the quality of life of those in their care on a daily basis,” said FHCA CEO Emmett Reed. “Both Krista and Theo have bright futures ahead, and FHCA is proud to support them in their careers to help meet the needs of Florida’s senior generation.”
FHCA has awarded $2750 in scholarships to long-term care professionals this fall. Each recipient is considered among the best and brightest working in FHCA member nursing centers and assisted living facilities. Nolan received $750 to help her pursue a degree in Health Services Administration, and Danet received $750 as he studies to be a physical therapy assistant.
“Krista and Theo have such a positive impact on our residents and their fellow co-workers; both are well deserving of this award,” said Scott Allen, administrator of Menorah Life and FHCA Past President. “We are so excited for this growth opportunity and look forward to their continued success in the profession.”
Nursing centers across the country are facing workforce shortages. A recent study found that while nursing and residential care had the highest wage growth across health care settings, employment in those fields is still 5.7% below pre-pandemic levels.
The Career Climb Scholarship was established to provide resources for FHCA member nursing centers and assisted living facility staff to further their education and advance their long-term care careers.
Award recipients must currently be enrolled in a program to advance their studies, demonstrate a commitment to the residents entrusted in their care, show leadership potential among their peers, and share a personal story describing why they are choosing to advance their long-term care career.
Scholarships are awarded twice yearly and funded through the Florida Health Care Education & Development Foundation, FHCA’s charitable foundation.
— Bills of interest —
Here is a list of health care-related bills filed in the House and Senate between Oct. 18 and Oct. 25 that we will be tracking:
HOUSE:
HB 253 by Rep. Michael Caruso — Medicaid Coverage for Prescribed Foods for Disease Treatment and Prevention: Requires AHCA, in conjunction with DOH, to establish Food Is Medicine Pilot Program to provide Medicaid coverage for purchases & deliveries of prescribed health-promoting foods; requires AHCA, in conjunction with DOH, to seek federal approval & waivers for the pilot program; requires federal waiver application to seek matching funds; requires referrals of pilot program patients to specific federal & federally funded programs; requires allocation of portion of pilot program implementation budgets to specified organization for the establishment of specified center; provides operation requirements for center.
HB 255 by Rep. Carolina Amesty — Psychiatric Treatments: Defines “electroconvulsive treatment” & “psychosurgical procedure” and provides only physicians may perform such treatment & procedures; prohibits the performance of such treatment & procedures on minors.
HB 265 by Rep. Katerine Waldron — Medicaid Coverage for Behavioral Health Interventions: Requires AHCA, in conjunction with DOH, to create Emergency Room Utilization Mitigation Behavioral Health Intervention Pilot Program to provide Medicaid coverage for purchases & deliveries of prescribed healthful foods & certain counseling, therapy, & education to reduce emergency room visits; requires agency, in conjunction with the department, to seek federal approval & waivers for the pilot program; requires federal waiver application to seek matching funds; requires allocation of a portion of pilot program implementation budget to a specified organization for the establishment of specified center; requires referrals of program patients to certain federal & federally funded programs; requires the agency to accept certain entities as essential statewide Medicaid providers under pilot program.
HB 257 by Rep. Mike Giallombardo — Autonomous Practice by a Certified Registered Nurse Anesthetist: Revises staff membership & clinical privileges for certified registered nurse anesthetists; authorizes certified registered nurse anesthetists to perform specified acts; revises practice requirements for an autonomous advanced practice registered nurse & for certified nurse midwives; authorizes autonomous advanced practice registered nurse to perform certain acts; provides for expiration of Council on Advanced Practice Registered Nurse Autonomous Practice; authorizes certain advanced practice registered nurses to participate in Medical Education Reimbursement & Loan Repayment Program.
SENATE:
SB 228 by Sen. Tom Wright — Health Insurance Cost Sharing: Defining the term “cost-sharing requirement”; requiring specified individual health insurers and their pharmacy benefit managers to apply payments by or on behalf of insureds toward the total contributions of the insureds’ cost-sharing requirements; providing disclosure requirements for specified health insurers and their pharmacy benefit managers; requiring that specified contracts require pharmacy benefit managers to apply payments by or on behalf of insureds toward the insureds’ total contributions to cost-sharing requirements, etc.
SB 248 by Sen. Clay Yarborough — Medical Negligence: Specifying which medical expenses resulting from medical negligence may be recovered by a personal representative or canceled by a court; expanding the class of survivors who may recover noneconomic damages due to a wrongful death caused by medical negligence; providing that such recoveries are contingent upon certain findings or determinations by the Agency for Health Care Administration or the Department of Health, etc.
SB 252 by Sen. Rosalind Osgood — Psychiatric Treatments: Defining the terms “electroconvulsive treatment” and “psychosurgical procedure;” providing that only a physician may perform electroconvulsive treatment and psychosurgical procedures; prohibiting the performance of electroconvulsive treatment and psychosurgical procedures on minors, etc.
SB 256 by Sen. Lauren Book — Pregnancy Support and Wellness Services: Revising contract requirements for the Florida Pregnancy Care Network, Inc.; requiring the Department of Health to conduct annual visits to each organization within the network, etc.
— RULES —
— The Board of Podiatric Medicine proposes amending Rule 64B18-17.001 to conduct a comprehensive review and to determine if there are any needed updates, changes, or corrections to the rule language. More here.
— The Board of Pharmacy proposes amending Rule 64B16-28.120 to update information regarding the incorporated rule chapter. More here.
— The Board of Opticianry proposes amending Rule 64B12-9.0015 regarding the completion of a two-hour laws and rules course by a Board-approved laws and rules course provider. More here.
— The Board of Opticianry proposes amending Rule 64B12-15.008 regarding continuing professional education credit for videocassette courses. More here.
— The Board of Opticianry proposes amending Rule 64B12-15.001 regarding initial licensure renewal and a two-hour education course on medical errors. More here.
— LOBBYISTS —
Jason Allison, Robert Hosay, Foley & Lardner: Patient Funding Alternatives
Mary DeLoach, Avery Lopez, The Southern Group: Good Health Clinic
Michelle Grimsley: Florida Alliance of Planned Parenthood Affiliates
Anna Lewis, Metz Husband & Daughton: Florida Psychiatric Society
Christian Minor, Converge Public Strategies: Florida Veterinary Medical Association
— ETC —
— National First Responders Day is Saturday, and LSF Health Systems is teaming up with partner organizations to provide peer support to first responders. In the last five years, more than 1,200 first responders in the U.S. have taken their own lives — 20% of those first responders were from Florida. First responders face many unique challenges and peer specialists are individuals who have lived similar life experiences. These former first responders understand firsthand the mental health issues that first responders face. The peer support program provides the following services: peer support, support groups, and funding for therapy. More information is available at StayFitForDuty.org.
— The Rehabilitation Center of the Palm Beaches submitted a certificate of need to AHCA to add 10 community nursing home beds. The proposed project costs nearly $4.7 million. More here.
— The CDC has updated its COVID-19 vaccination guidance for children who have gone from 4 years old to five during the initial COVID-19 vaccination series and children who are moderately or severely immunocompromised and turn from age 11 to age 12. The CDC also has updated guidance for the interchangeability of COVID-19 vaccinations. More here.
— Centene has been named to the 2023 Fortune Best Workplaces for Women list, ranking 67 out of 100 companies in the Large Company category. This marks the first time Centene has appeared on the annual list, which recognizes companies that demonstrate high employee-ranked scores in trust, fairness and pride among women employees.
— ROSTER —
— University of Miami Miller School of Medicine, Henri R. Ford, M.D., MHA, was installed for a one-year term as the 104th president of the American College of Surgeons (ACS). Ford is a world-renowned pediatric surgeon, prolific physician-scientist, and dean and chief academic officer of the Miller School of Medicine. Ford has chosen the theme, “Achieving Our Best Together,” to guide his time as president of the ACS.
— Shlermine “Shea” Everidge, M.D., joins Tallahassee Memorial HealthCare and TMH Physician Partners-General Surgery. She is the area’s first fellowship-trained breast surgical oncologist, graduating from the Breast Surgical Oncology Fellowship Program at M.D. Anderson Cancer Center in Houston earlier this year.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
Sleep Battles: “Dr. Sleep” is the name of a 2013 Stephen King novel and follow-up to the 1980s flick, The Shining. It could also be the title of the real-life fight over the delivery of anesthesia in Florida and who is authorized to do what. Two Republicans are sponsoring legislation this year that strikes a requirement for certified registered nurse anesthetists (CRNAs) to put patients under without having to enter into written protocol agreements with physicians. Rep. Mike Giallombardo says striking the paperwork requirement will help improve access to health care and will keep highly trained nurses working in the state. But opponents say HB 257 is “scope creep” and will work to kill it.
Crackdown: Senate Democratic Leader Lauren Book filed a pair of related bills (SB 254, SB 256) to safeguard women seeking reproductive health care services. One would ban protests 150 feet from a reproductive health clinic and prohibit interfering with the people working at or going to them. The other would regulate crisis pregnancy centers (CPCs) that present themselves as reproductive health clinics but are, in fact, nonmedical facilities working to dissuade people from accessing abortion care and contraceptives, among other health options. Florida now provides $25 million yearly to them. If approved, the measure would require the Department of Health to annually audit every site overseen by the nonprofit Pregnancy Care Network and prohibit CPCs from sharing medically inaccurate information.
‘Live Healthy’: Sen. Colleen Burton said during a 2023 Future of Florida panel that the state has “multifaceted” shortages across various health care professions in the state and hinted that it will be one of the areas targeted by the Senate’s upcoming “Live Healthy” initiative championed by Senate President Kathleen Passidomo. Burton said that while Floridians are “fortunate to live in a rapidly growing state,” it puts more pressure on the health care system, which was already dealing with shortages in areas such as nursing during the COVID-19 pandemic. She said that one item under consideration is to boost state funding for medical residency programs for medical school graduates because, currently, the state does not have enough slots for all the students graduating.
Tough to guesstimate: State economists sound skeptical that they will be able to put a price tag on a proposed constitutional amendment to protect access to abortion by a November deadline if the measure makes it to the 2024 ballot. The quartet of state economists, sitting as the Financial Impact Estimating Conference (FIEC), said it’s unlikely that the Supreme Court will issue a ruling on the state’s 15-week abortion ban passed in 2022 before its November deadline. Given that, the economists are leaning toward developing a financial statement explaining why they could not score the proposed amendment, a position they are allowed to take but something the group tries to avoid, said Office of Economic and Demographic Research and chief economist Amy Baker.
OP-ED: Since I lost my baby more than 30 years ago, every part of who I am and what I do has changed. Loss like this can bring lifelong trauma to a mother and her family but also heightened awareness of life — how precious it is and how fragile it is. October is Pregnancy and Infant Loss Awareness Month — a time to honor and remember the lives of children lost during pregnancy or infancy and the mothers who were changed forever by this loss.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“10 Medicaid holdout states scramble to improve health coverage” via Anna Claire Vollers of Stateline — The Republican-led states that have refused to expand Medicaid are trying a variety of strategies to save struggling hospitals and cover more people without full expansion, which was one of the key provisions of the Affordable Care Act. States such as Alabama and Florida have bumped spending on programs that serve specific populations, such as pregnant women or residents with mental health needs. Florida, too, has tried more limited alternatives to full expansion, said Erica Monet Li, a policy analyst at the Florida Policy Institute, a nonpartisan and nonprofit research organization based in Orlando. “Every legislative session we see small bills that legislators try to pass for certain Medicaid-ineligible populations,” said Li. One example, she said, was a bill from this year’s legislative Session that would have expanded Medicaid for certain disabled populations; it died in committee.
“School health screenings plunge in Central Florida under parents’ rights law” via Leslie Postal of the Orlando Sentinel — Florida’s public schools historically have checked thousands of students a year for vision, hearing and growth problems, hoping to catch early health issues that can impede academic achievement. But the number of students screened in Orange and Seminole public schools last year plummeted after Florida passed a new law requiring parents to give written permission for their children to participate in school-based health screenings. Orange County Public Schools, for example, screened nearly 55,000 students for vision problems during the 2021-22 school year but fewer than 14,000 students during the 2022-23 school year, a drop of almost 75%. Seminole County Public Schools screened about 7,100 students for vision problems last school year, down from nearly 18,000 the prior year.
“Trans kids face health, social issues with new Florida law, state rules” via CA Bridges of the Daytona Beach News-Journal — When Ollie was just 16 years old, they were so afraid to use the bathroom in their Collier County school that they would get panic attacks and vomit. Ollie realized they were trans and nonbinary during their sophomore year. They continued using the women’s restroom, but as they presented as more masculine, they started to get uncomfortable looks or stares. They feared going into the men’s restroom; the boys at school would elbow them, film them without permission, bark in their faces and verbally abuse them. After a year of this, they developed kidney stones. “I just felt like prey,” Ollie said. Kids across Florida are dealing with the same situation as Ollie, but now, they have even more to fear: state-sanctioned punishment by school authorities. Fear of — and refusal to use — public bathrooms isn’t new, LBGTQ advocates say, but it’s gotten worse since new legislation passed this Summer.
“Forum addresses health, wellness issues with Black women” via Trevor Pettiford of Bay News 9 — Over the weekend, women of color in St. Petersburg shared their experiences with breast cancer, domestic violence and mental health. The program, called “Living Beyond Our Scars,” had speakers who had lived through some of the most challenging issues anyone could face and prevail. “This event was designed to create a safe space so that we can talk about the things that impact us the most, especially during this time of year,” said event host Sharlene Emmanuel Edwards. “Breast cancer, domestic violence and mental wellness impact Black women at a disproportionate rate than others in the community and we really wanted to create an afternoon of just healing, talking and sharing stories that can help us move forward and learn.” According to the American Society of Clinical Oncology, it’s estimated that 43,000 women will die from breast cancer this year in the United States. Black women are 40% more likely to die than white women and 30% more likely than Hispanic women.
“Halifax reports ‘record number’ of trauma patients admitted during Biketoberfest” via the Daytona Beach News-Journal — Halifax Health is reporting a “record number” of trauma patients over the Biketoberfest weekend, with 39 admitted over a four-day period, according to a news release. Of the 39, 19 were wearing helmets, according to the hospital. It was a six-patient increase in patients with trauma admissions over last year’s event. Of those, 14 were wearing helmets. “The beautiful weather we experienced over the weekend most likely contributed to a slightly larger crowd for Biketoberfest,” said Director of Emergency and Trauma Services Lindsay Duffy. Of the 39 patients with Trauma injuries, nine were Volusia County residents, and 17 patients were from out of state.
— PENCIL IT IN —
Friday
2 p.m. — Submission deadline for questions about the Medicaid dental ITN. AHCA comment email address here.
Sunday
Happy birthday to Rep. Melony Bell.
Tuesday
Happy Halloween!
Wednesday
Open enrollment in the federal health care Marketplace begins.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson and Phil Ammann.
