Diagnosis for 12.14.23: 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.

— Still No Deets —

Gov. Ron DeSantis says he is still working on a plan to replace Obamacare but also suggested that his proposal will have “broad strokes” and may not have in-depth details.

DeSantis is an opponent of both Obamacare and Medicaid expansion, which was part of it. He has pledged as a presidential candidate to spell out what he wants to replace it with if he were to get elected.

During a CNN-televised town hall in Iowa this week, DeSantis reiterated that he would announce his plan “when we get deeper in the election season” and that he is working with experts and members of Congress to craft his replacement plan.

“It’s the type of thing where, you know, we’re putting out the broad strokes,” DeSantis said. “You kind of campaign in poetry, then you govern in prose with that. But we are absolutely going to be dealing with insurance. We’re going to be dealing with — we’re going to deal with pharmaceuticals. We’re going to be dealing with all those things.”

During his time as Governor, DeSantis’ health care initiatives have focused primarily on COVID-19 and the cost of prescription drugs. He pushed against vaccine and mask mandates and asked for a statewide grand jury to investigate the actions of vaccine manufacturers. DeSantis also backed a move to have the state get involved in importing drugs from Canada, but the program has yet to win federal approval.

DeSantis told Iowa voters his plan will address accessibility, affordability, and “accountability in the system.” He maintained that patients are “at the back of the bus” behind insurance companies, drug companies, and “big government bureaucracies.”

“It’s an iron triangle that really is a system rather than something that’s an individual care. So, we want to make sure that people are protected. I think your insurance should be portable. The whole reason the pre-existing condition came is because it was tied to people’s jobs. So, if you lost your job while you were sick, then all of a sudden, in the past, you wouldn’t do — that insurance should be able to go with you. So, we’re going to work on all those things.”

___

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

— We’re No. 1 —

Speaking of Obamacare, Florida continues to lead the nation in the number of residents signing up for health insurance coverage through the federal insurance marketplace.

The enrollment deadline is Jan. 15, but those seeking coverage starting on Jan. 1 must sign up by this Friday.

Federal data shows that more than 1.83 million Floridians, out of nearly 7.3 million Americans, had enrolled as of early December. Florida is followed by Texas, which has 1.42 million enrollees.

More than 3.2 million Floridians currently receive coverage through the marketplace, an increase of more than 500,000 from the prior year.

Florida is one of 32 states that does not rely on a state-specific enrollment platform for residents to shop for health plans and instead depends on the federal marketplace website HealthCare.gov.

According to recent U.S. Census estimates Florida continues to have one of the nation’s highest uninsured rates. Republican governors and the Florida Legislature have steadfastly refused to expand who is eligible for Medicaid coverage included in Obamacare when first signed into law.

— ABCs of Living Healthy —

Senate President Kathleen Passidomo unveiled her Live Healthy proposal. As expected, the proposal does not expand Medicaid under the federal health care law called Obamacare.

But she directs hundreds of millions in Medicaid fee increases. The Live Healthy proposal — contained in SPB 7016 and SPB 7018 — has been widely acclaimed for its approach to bolstering the state’s workforce and access to care. But there are things in the lengthy bill that have raised some eyebrows, including the authorization of “advanced birth centers,” or ABCs. Hospitals, which stand to lose patients to the new facilities, aren’t pleased.

SPB 7016 requires ABCs to be open 24 hours a day, seven days a week. ABCs must employ two medical directors, one of whom must be a board-certified obstetrician and one a board-certified anesthesiologist. They must also employ at least one registered nurse and ensure that at least one registered nurse is present in the center and can stabilize and facilitate the transfer of patients, mothers and newborns, if necessary.

Under the bill, an advanced birth center can only serve patients who expect to have normal pregnancies and deliveries. Before being accepted for care, the patient must sign an informed consent form.

The bill requires a mother and infant to be dismissed from an advanced birth center within 48 hours after vaginal delivery of the infant or within 72 hours after delivery by cesarean section. If a mother or an infant is retained at the advanced birth center beyond those time frames, the ABC must file a report with AHCA within 48 hours after the scheduled discharge time and describe the circumstances and the reasons for the decision.

AHCA is charged with crafting and passing regulations for ABCs. The SPB also requires the proposed regulations for ABCs to be equivalent to ambulatory surgical centers regarding quality of care, blood transfusions, food handling and food service.

This is not the first time the Legislature has considered authorizing so-called ABCs.

Lawmakers last debated the merits of ABCs in 2018 under then-House Speaker José Oliva. The hospital industry killed the legislation, and it hasn’t resurfaced until now.

Hospitals aren’t the only providers that may have a concern with some of the provisions in the bill. In the past, physicians have beat back efforts to have interstate licensure arrangements for physicians or to make it easier for physicians trained in other countries to practice in Florida. SPB 7016 contains both of those provisions.

— It’s a Hit —

Undoubtedly, Passidomo’s proposal is a hit with the health care lobbyists in Tallahassee.

Here are some statements published after the Senate Health Policy Committee voted to introduce the proposal for the 2024 Session.

“AARP Florida applauds the Senate’s recognition of the significance of addressing health care workforce needs in the state,” said AARP Florida State Director Jeff Johnson. “We support the Live Healthy initiative because a robust health care system is a fundamental component of an age-friendly or livable community. Even though this bill is premised on projections of a future shortage of health care providers in Florida, some residents are already encountering difficulties in getting the care they need today. This shortage echoes across the health care profession, particularly impacting long-term care providers, both in-home and in institutional settings, jeopardizing the health and well-being of vulnerable adults in need of assistance.”

Johnson added that AARP Florida would also like lawmakers to remove barriers that prevent health care workers who retire in good standing from returning to the workforce if they choose.

“With the increasing cost of living, many retired health care professionals are eager to rejoin the workforce. This constitutes a pool of highly trained, skilled nurses and other health care workers poised to address an immediate shortage,” Johnson said.

Florida Behavioral Health Association President and CEO Melanie Brown-Woofter called the plan a smart, holistic approach to health care workforce issues.

“In every corner of the state, community behavioral health providers help our friends, family members, and neighbors with the support and treatment they need to address mental health and substance abuse disorders. However, like many other health care providers, we too are facing a shortage of clinicians and need help to overcome obstacles to securing a stable workforce and thereby serve those seeking care,” she said.

“We are fortunate to have leaders who not only recognize the challenges of keeping and growing a strong health care workforce but also provide resources and innovative thinking to meet the needs of all Floridians.”

— 3 Questions —

CVS Caremark is the pharmacy benefit management subsidiary of CVS Health, the nation’s largest pharmacy chain with over 9,000 locations. Phil Blando, executive director of corporate communications for CVS Caremark, spoke with Diagnosis to discuss pharmacy benefit managers and the company’s priorities for the 2024 Session that begins Jan. 9.

Q: Florida passed a far-reaching PBM law last year, which your company did not support. Do you expect any “tweaks” in the upcoming Session, and if so, where does CVS stand on those changes?

Blando: We think what is most important right now is working with all the appropriate agencies and our clients to ensure the law’s implementation and understand its effects. Our goal is always to provide an affordable, accessible pharmacy benefit that serves Floridian patients and small businesses. During the 2024 Legislative Session and beyond, we will continue to engage with lawmakers to promote policies that support choice and affordability in pharmacy benefits.

Q: The U.S. Court of Appeals for the 10th Circuit issued a decision in PCMA v. Mulready, litigation against Oklahoma’s PBM law, similar to Florida’s law. The ruling presents a victory for the PBM industry on all its legal arguments. What impact, if any, does that have on Florida law?

Blando: The federal Employment Retirement and Security Act (ERISA) provides important protections that allow multistate companies to offer standardized health care coverage across the U.S. without having to navigate a patchwork of inconsistent state laws that could create disparities and inefficiencies. Protecting ERISA is vital for ensuring access to pharmacy benefits.

Q: What is CVS’ priority for the upcoming Session?

Blando: Sen. Jay Collins has introduced SB 444, which is an important step to expanding pharmacy access by allowing for telepharmacy in Florida. These provisions are an important step in evolving how pharmacies can better serve patients.

— LOBBYISTS —

Christopher Chaney, The Advocacy Partners: Nurse-Family Partnership

James McFaddin, Sydney Ridley, The Southern Group: Emergent BioSolutions

Christian Minor, Steve Schale, Sarah Busk Suskey, Converge Public Strategies: Milan Laser Hair Removal

Jared Rosenstein, Capital City Consulting: Florida Association of Nurse Anesthesiology

—ETC —

— Bah humbug and gobble gobble? Medicaid providers won’t be paid on time, and AHCA blames the holidays. AHCA sent a provider alert this week saying there was a delay in verifying weekly Medicaid funding and that provider payments for the week of Dec. 27, 2023, won’t be available until Dec. 29, 2023. The alert advised that payments for the week of Jan. 3, 2024, won’t be available until Friday, Jan. 5, 2024. It’s the second time in as many months that AHCA has alerted providers of a payment delay. AHCA sent a nearly identical alert on Nov. 15 saying that payment would be late “due to a delay in verifying weekly Medicaid funding.” The November alert also said it was a “one-time delay with the regular weekly Thursday payment schedule. Due to the holiday falling on the regular weekly Thursday schedule, payment will be made on Wednesday, Nov. 22, 2023.” According to sources, the November delay impacted fee-for-service payments and managed care payments.

— Baptist Hospital was named by U.S. News & World Report as its 2023-2024 Best Regional Hospitals as a high-performing facility for seven areas of care: heart attack, heart failure, stroke, COPD, pneumonia, knee replacement, and hip replacement. Baptist is the only hospital in Northwest Florida to receive the title, the highest distinction a hospital can earn for U.S. News Best Hospitals Procedures & Conditions ratings.

— Can a Florida pharmacist convert a prescription for a non-controlled substance initially written for a 30-day supply with 11 refills to a prescription for a 90-day supply with three refills without receiving additional prescriber authorization? The Florida Board of Pharmacy has been asked to investigate the issue.

— ROSTER —

— Becker’s Hospital Review has named Tampa General Hospital EVP and Chief Administrative Officer Stacey Brandt as one of 65 Health System Chief Strategy Officers (CSOs) to Know in 2023.

— Kristen Jiminez, CSO at Advent Health Central Florida Division in Orlando, also made Becker’s list of Health System Chief CSOs to Know in 2023.

— ICYMI —

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

Fine commits to APD: A powerful House Republican said providing services to people with disabilities is one of his top priorities for the 2024 Session. House Health & Human Services Committee Chair Randy Fine told Florida Politics that he is concerned about the number of people on the waitlist for the Medicaid iBudget program, a waiver program that provides home- and community-based services to people with intellectual and developmental disabilities.

Stumping for the boss: Florida’s Surgeon General will be outside the state later this month, stumping on behalf of the Governor’s presidential campaign. Joseph Ladapo will be in the U.S. Virgin Islands, appearing at Republican Party receptions on Dec. 17 at St. Thomas and Dec. 18 at St. Croix to aid DeSantis’ campaign for the party’s nomination.

It’s here: Senate President Passidomo’s Live Healthy initiative aims to bolster Florida’s health care workforce and infrastructure and directs hundreds of millions to help. The price tag fluctuates — Passidomo herself said it was $750 million, though other documents suggest it’s closer to $874 million.

No report, no problem: Rape kit evidence would be to be stored for at least eight years after being gathered, even if a crime was not reported to law enforcement. The House Criminal Justice Subcommittee gave its nod to legislation (HB 607) that Republican Rep. Rachel Plakon of Lake Mary proposed. Orlando-area Democratic Sen. Linda Stewart has introduced a similar bill (SB 764) awaiting its first committee hearing.

Drunken driving crackdown: Sen. Nick DiCeglie is bringing back legislation that would require drivers who have their license suspended for a suspected DUI to install interlock devices in their cars, even if they refused a Breathalyzer. The legislation (SB 260) moved through its first committee stop in front of the Senate Transportation Committee, but not without some questions from Democrats on the panel.

— FOR YOUR RADAR —

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

“Tampa General gets greenlight for $510 million Davis Islands expansion” via Christopher O’Donnell of the Tampa Bay Times — The skyline on Davis Islands is set for a remake. According to hospital officials, on Thursday, Tampa City Council members approved a rezoning request from Tampa General Hospital to begin constructing a 13-story pavilion, which will become the tallest structure on the islands. The $510 million project is the centerpiece of the hospital’s master plan to meet the region’s growing demand for health care. The 565,000-square-foot structure will be constructed adjacent to the hospital’s main building, adding 144 beds, 32 operating rooms and a new intensive care unit.

“Safety Trend Report reveals significant challenges for health care professionals and consumers” — Stericycle has released its third annual Healthcare Workplace Safety Trend Report studying how providers and administrators in the U.S. view health and safety in their organizations and its impact on peers, patients, and surrounding communities. This year, the study also surveyed consumers about their safety concerns when seeking care. The report aims to provide valuable insights into the challenges the industry and patients face today and how to help health care organizations understand their safety profiles, improve workplace safety standards, create a quality care environment, and reduce environmental impacts.

“Ric Bradshaw’s son-in-law paid by a private company to serve as PBSO’s medical director” via Mike Diamond of the Palm Beach Post — You won’t find Palm Beach County Sheriff Bradshaw’s son-in-law on the agency’s payroll, even though he is providing part-time medical director services for the Palm Beach County Sheriff’s Office (PBSO), a position that, according to invoices, costs taxpayers about $100,000 a year for 30 hours of work a month. Dr. Peter LoFaso, 53, married to Bradshaw’s stepdaughter Kelly, was brought in by a private company to do the job. Bradshaw, 75, approved an expansion in 2020 of the office’s employee benefits-insurance brokering contract with the Gehring Group to include the services. LoFaso was guiding PBSO the day after the agreement was signed, Sheriff’s Office emails show.

“Escambia County approves $90,000 settlement with former medic tied to training scandal” via Jim Little of the Pensacola News Journal — The Escambia County Commission approved a $90,000 settlement with a former paramedic tied to the 2019 training document scandal in a divided 3-2 vote on Thursday. Escambia County will pay former Emergency Medical Services head of administration Katherine Kenney $90,000, and her termination from the county will be changed to a resignation in her personnel file. Kenney was fired from Escambia County in 2020 after she was one of four former EMS members arrested and charged with 11 felony counts and four misdemeanor counts related to falsifying training documents.

—PENCIL IT IN —

Thursday

Happy birthday to Rep. David Borrero.

8 a.m. — The House Health Care Appropriations Subcommittee will be updated on the Canadian Prescription Drug Importation program and Medicaid managed care saving rebates. Location: Room 17, House Office Building. Notice here.

1:30 p.m. — The FX Executive Steering Committee (ESC) will hold a Microsoft Teams Webinar. Register for the meeting here. Agenda here.

Monday

Happy birthday to Rep. Jennifer “Rita” Harris.

Wednesday

1:30 p.m. — Economic and Demographic Research members meet to discuss the state employees’ health insurance trust fund.

___

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