Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Florida is once again leading the nation in the number of people relying on Obamacare for health insurance as more than 4 million residents have signed up according to the latest numbers released by the Centers for Medicare & Medicaid Services.
More than 20 million Americans are relying on health coverage either through Healthcare.gov or state-created marketplaces — a record according to federal officials. Florida’s overall numbers have jumped from 3.2 million in 2023 to 4.03 million this year, CMS reported Wednesday.
The numbers could still climb even higher as the enrollment deadline for the year is next week.
Other states with a high number of enrollees are Texas, with nearly 3.3 million, and California, with 1.7 million.
Florida and Texas are among the 10 states that have rejected expanding Medicaid eligibility as allowed under Obamacare — known officially as the Affordable Care Act — and are among the states with the highest uninsured rates in the nation. Senate President Kathleen Passidomo during her opening day remarks said she would focus on health care during this year’s Session but said she was adamantly opposed to Medicaid expansion.
The administration of President Joe Biden touted the record-high Obamacare numbers which come as Republican candidates for president including former President Donald Trump and Gov. Ron DeSantis vow to repeal Obamacare and replace it. DeSantis has said he plans to roll out his alternative sometime this year although he has not given an exact timeline.
Biden, in a statement, called the enrollment numbers a “major milestone.”
“With six days left to still get covered, 8 million more Americans have signed up for ACA coverage than when I took office,” Biden said.
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—Medicaid expansion —
Senate President Passidomo, whose top priority is her “Live Healthy” health care overhaul (SB 7016), used her opening day Session remarks this week to push back against Democrats who continue to urge Florida to expand Medicaid eligibility.
But she wasn’t alone in forcefully pushing back against expansion. House Speaker Paul Renner said this week that the state should help provide health care to the elderly, the poor and the vulnerable but should not spend money on coverage to low-income adults without children who could be working.
“You are really talking about a philosophical perspective that health care is a right at that point — that I’m sitting home as a 40-year-old living with my parents playing Xbox and I should be able to knock on your door and say, ‘Pay my health insurance,’” Renner said.
Renner pointed out that Florida legislators have taken steps in recent years to bolster KidCare and Medicaid coverage, noting for example extra money put aside in 2023 to boost reimbursement rates to pediatric doctors. He predicted that the House would do more in that arena this year, including taking care of what he called “poverty cliffs” where people are afraid to leave public assistance because they would lose their health care.
“So you can’t do those things fiscally if you are down the path of everybody gets free stuff when they don’t really fit in that social safety net,” Renner said, adding that here were “strings attached” to accepting extra federal money to pay for Medicaid expansion, as allowable under the federal health law often referred to as Obamacare.
Florida is one of 10 states that has not expanded Medicaid to low-income, childless adults as allowable under the federal law.
— Amendments rolling in —
The Senate is expected to take up Live Healthy in the Senate Fiscal Policy Committee on Thursday. It’s the second — and last — committee of reference for the sweeping health care proposal.
At press time, nine amendments had been filed to the Live Healthy proposal. All were filed by bill sponsor Sen. Colleen Burton. One amendment addresses dental loan repayment and the Florida Reimbursement Assistance for Medical Education (FRAME) program, deleting a requirement from the bill that allowed advanced practice registered nurses to qualify only if they practiced in a primary care setting.
Another amendment addresses advanced birth centers, deleting a provision in the bill that required the Agency for Health Care Administration through rule to a process for designating a birth center as an “advanced,” which allows them to conduct cesarean sections.
Burton’s amendment deletes the requirement that AHCA develop a rule and instead authorizes the agency to “develop any requirements or standards it deems necessary for patient safety which advanced birth centers must meet as a condition of the designation.”
— FHA priorities —
The state’s largest hospital association heads into the 2024 Session with an ambitious agenda that includes changes to Florida’s “prompt payment” and “prior authorization” laws, funding increases for hospitals that deliver children, and a study on the funding of mental health services in the state.
Florida Hospital Association President and CEO Mary Mayhew says she’s going to show the nexus between prompt payment and meaningful prior authorization requirements contained in SB 1574 and fortifying the state’s health care workforce.
“One of the areas that is so frustrating for providers, and can cause physicians to retire early and it can lead to providers not wanting to accept insurance, is the overwhelming administrative burden of chasing authorizations for care and chasing payments for care that’s been provided,” Mayhew told Florida Politics.
While the health insurance issues aren’t currently included in SB 7016, Mayhew isn’t worried.
“There’s certainly a strategy that the Senate leadership has focused on in terms of how the various proposed proposals within her comprehensive bill hang together,” Mayhew said, adding, “I don’t believe that prevents serious consideration of opportunities to increase accountability for insurance companies to timely authorize access to care and to promptly pay.”
While her prompt payment and prior authorization issues aren’t included in Live Healthy, the omnibus health proposal does include $82 million to increase reimbursement for obstetric care. “Medicaid pays, 46% of all births in Florida were reimbursed at 35 cents on the dollar of cost. So we are really grateful that the Senate President has supported that. The Governor in his budget supported a reimbursement rate increase for hospitals for those services, too.”
Passidomo also included in her Live Healthy proposal authorization for Medicaid to seek authority from the federal government to reimburse hospitals for health care provided at home. Sixteen hospitals have gotten approval from the Centers for Medicare & Medicaid Services to participate in the “hospital @ home care” program and the state provides regulatory oversight.
“It re-imagines how care can be delivered because of the explosion in new technology that allows for more sophisticated remote monitoring of patients. And that just opens up a world of possibilities to better support individuals, especially to support them in their homes,” Mayhew said.
Also included in the FHA’s agenda is an ask that the Legislature require a study on the amount of money outside of the Medicaid program the state spends providing mental health services to Medicaid-eligible people.
“This is my constant drumbeat. So we want to effectively maximize current available federal Medicaid funds for existing Medicaid enrollees. There are children, in particular — but also adults — who are today enrolled in Medicaid. But their mental health services are being paid for through the Department of Children and Families. And these are generally Medicaid-reimbursable mental health services, but we are now not drawing down a two-to-one match (of federal dollars). Those services are being paid for 100% through state dollars through the Department of Children and Families. So every dollar being spent on someone who was covered by Medicaid is $1, that potentially cannot then be spent on someone who is truly uninsured.”
— Managed care updates —
Four managed dental plans responded to the statewide Medicaid prepaid dental program invitation to negotiate: Avēsis of Florida; DentaQuest of Florida; LIBERTY Dental Plan of Florida; and Managed Care of North America.
AHCA sent a Medicaid alert Monday afternoon posting the names of the managed dental plans and asking providers to complete an online survey about their experiences with the managed care plans. The survey must be completed by 5 p.m. Jan. 22.
AHCA intends to enter into negotiations with the dental plans between Feb. 5 and March 1 and will electronically post the names of the plans it intends to ink contracts with March 29.
And in other Medicaid ITN-related news, the state was expected this week to begin negotiations with the companies that submitted the highest-scoring responses to the Medicaid managed care invitation to negotiate.
The latest timeline has the state negotiating with the plans between Jan. 8 and Feb. 16. AHCA anticipates posting notice of its intent to award contracts on Feb. 23.
AHCA currently has contracts with three of the four respondents. Avēsis of Florida, a third-party administrator, does not currently have a Medicaid dental contract in Florida. However, according to its website, Avēsis partnered with SmileMD in 2020 to offer in-office general anesthesia services for dental procedures to managed care organizations (MCOs) in Kentucky. SmileMD is a medical anesthesiology group with the capability to provide full anesthesia services in dental offices, which negates the need to contract with hospitals.
Meanwhile the third Medicaid ITN, the CIDD pilot program for people with intellectual or developmental disabilities, also is in full swing. Simply Healthcare Plans, Sunshine State Health Plan and Florida Community Care, each of which currently has Medicaid managed care contracts with the state, submitted questions about the ITN. According to the timeline, AHCA will negotiate with vendors that submitted the top-scored proposals between Jan. 22 and Jan. 26. The timeline has AHCA posting its intent to award a contract on Jan. 31.
— RULES —
—The Board of Dentistry proposes amending Rules 64B5-15.009 and 64B5-15.0121 regarding the fee for reactivation of an inactive license and change of state processing fee for retired professionals. More here.
— LOBBYISTS —
The top of the year brings a slew of new lobbyist registrations (too many to mention here). In lieu of health care lobbyist registrations, Diagnosis this week is providing lobbying information on some of the high-profile bills. There are 23 registrations for Passidomo’s Live Healthy initiative (SB 7016) and another lobbyist registered for SB 7018, a bill that establishes a Health Care Innovation Council and charges it with awarding low-interest loans.
—ETC —
—Five licensure applicants have filed petitions for variances with the Board of Pharmacy asking it to make a provision in a rule that requires foreign pharmacy graduates to demonstrate proficiency in the use of English by passing the Test of English as a Foreign Language Internet-based test (TOEFL ibt). Silson George Lonth, Traiza Mehany, Ahmed Ismail, Engy Mossad and Traiza Mehany submitted petitions to the board on Jan. 3.
—AARP announced a new round of grant opportunities. It is accepting 2024 Community Challenge Grant Applications through March 6. The grants g fund quick-action projects to help improve public places, transportation, housing, and digital connections that help make communities more livable. To submit an application and view past grantees, visit www.AARP.org/CommunityChallenge.
—ROSTER —
— Bernardo “Bernie” B. Fernandez Jr., M.D., former CEO of Baptist Health Medical Group and Cleveland Clinic Florida, has been named Broward Health’s new Corporate Physician Executive. Fernandez has been charged with driving the growth of the Broward Health Physician Group.
— Ashwin Shivakumar, MD, MSPH, FACP, SFHM, CPE has been named chief medical officer for HCA Florida Trinity Hospital. He spent the last 14 years at Virginia Mason Franciscan Health in Washington serving as a hospitalist physician, lead hospitalist physician, associate regional medical director for hospital medicine and division director of inpatient services.
— Cullen Brown has been named chief executive officer of HCA Florida Poinciana Hospital. Brown will oversee the 94-bed acute care hospital in Poinciana, which has served Osceola and Polk counties for more than 10 years. Brown has more than a decade of experience in health care, having served in various leadership roles at HCA Healthcare.
— Justin Brand has been named the director of development at Lee Health Foundation. He will focus on philanthropy to support children’s services. Brand was named co-interim executive director for the foundation in June, 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.
No Medicaid expansion: Senate President Passidomo used her 2024 Session Opening Day remarks to champion her plan to beef up Florida’s health care workforce and make improvements in health care delivery. She also made clear that Medicaid expansion will not be part of her Live Healthy proposal.
Aging in place agenda: AARP Florida released an ambitious legislative wish list focusing on ways the Legislature can create livable communities, increase health security and protect consumers. Embedded in those three areas are recommendations that AARP Florida maintains will allow Florida residents to age in place.
Long shot: Democratic lawmakers in Florida are collaborating on a pair of bills to restore access to abortion and gender-affirming health care, block schoolbook bans, and reverse state policies barring so-called “woke” instruction in classrooms. Both bills are long shots, considering the Republican-dominant composition of the Legislature.
Finally: The Joe Biden administration gave two-year approval to Florida’s plan to import certain prescription drugs from Canada, making Florida the first state to receive such approval. The approval letter to Agency for Health Care Administration (AHCA) Secretary Jason Weida comes more than three years after the Gov. Ron DeSantis administration initially submitted its drug importation proposal to the Food and Drug Administration (FDA) for approval. Importation programs are allowed under Section 804 of the Federal Food, Drug, and Cosmetic Act.
Another RX proposal: On the eve of the 2024 Legislative Session and three days after the state received approval for a Canadian Drug Importation program, a leading House Republican announced his plan to lower prescription drug costs. House Health and Human Services Committee Chairman Randy Fine filed legislation (HB 1431) to establish “international reference pricing” for drugs, limiting prescription drug prices in Florida to those paid by other countries, including those with socialized health care.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“New suspensions and complaints concerning office surgery centers from Miami to Palm Beach” via David J. Neal of the Miami Herald — Eight licensed office surgery centers, spanning from Miami to Palm Beach, were hit in December with either suspensions or administrative complaints, which may end with suspension. Both the suspensions and the complaints come from the Florida Department of Health, although the time from violations to punitive actions can vary — some of the suspensions are based on inspections from 2021. Office surgery centers aren’t hospitals. If something goes very wrong, the facility has to be equipped to handle the situation until emergency medical services can arrive and get the patient to a nearby hospital where there’s a transfer agreement or the surgeon has staff privileges.
“Lloyd Austin leaves intensive care amid growing scrutiny of Pentagon secrecy” via Dan Lamothe, Matt Viser and Missy Ryan of The Washington Post — Defense Secretary Austin, whose failure to disclose his need for emergency hospitalization has ignited a firestorm, was moved out of intensive care on Monday, as Democrats and Republicans intensified their calls for accountability, and senior officials at the White House and Pentagon struggled to defuse the uproar. Their halting explanation of the situation, and Austin’s lack of transparency about what led to his health crisis, has only amplified the scrutiny following revelations that Austin’s senior staff declined to disclose the issue to the White House for days. The Pentagon said Monday night that it remains unclear when he may be released but that officials intend to provide daily updates so long as he remains at Walter Reed.
“DeSantis-led Florida has rejected $11B in federal funding in recent years” via Jeffrey Schweers of the Orlando Sentinel — DeSantis and state administrators have rejected at least $11 billion in federal funds in the past few years, saying there were strings attached, they “politicized” roads or fought climate change. The programs affected include an expansion of Medicaid, rebates for energy-saving appliances and upgrades, a program to cut motor vehicle emissions, and Summer lunches for children from low-income families. Millions of mostly low-income Floridians could have benefited from the funding, the Governor’s critics say. As the Legislature convenes to build next year’s state budget, federal COVID-19 recovery funds that have fueled tax cuts, road projects and padded the state’s $10 billion rainy day fund are drying up.
“Florida Surgeon General has safety concerns with COVID vaccines. FDA disagrees” via Michelle Marchante of the Miami Herald — Surgeon General Joseph Ladapo is urging people to stop getting Pfizer’s and Moderna’s mRNA COVID-19 vaccines over DNA-related safety concerns, despite the FDA reiterating that its research shows the vaccines are safe and outweigh the serious health risks associated with COVID-19. Ladapo, who has previously expressed concerns over the safety and effectiveness of the COVID vaccines, is questioning whether the mRNA shots could possibly deliver DNA contaminants into human cells. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, told Ladapo in a Dec. 14 letter that no SV40 proteins, a DNA virus, “are encoded for or are present in the vaccines” and that animal studies found “no evidence for genotoxicity from the vaccine.”
— PENCIL IT IN —
Thursday
Happy Birthday to Rep. Tommy Gregory
8:30 a.m. — Senate is in Session.
10 a.m. — The Senate Fiscal Policy Committee meets and will discuss SB 7016 and SB 7018, the Live Healthy proposal. 412 Knott Building.
11 a.m. — The House Healthcare Regulation Subcommittee meets. The committee considers HB 1501, a bill that, similar to SB 7018, creates a health Innovation fund. Room 102, House Office Building.
1 p.m. — The Senate Appropriations Committee on Health and Human Services meets and will consider SB 174, related to veterans’ long term care facilities admissions; SB 186, related to supranuclear palsy and other neurodegenerative disorders; and SB 214, related to child protective teams. Room 412, Knott Building.
Friday
9 a.m. — The House Select Committee on Health Innovation meets. Room 17, House Office Building.
Monday
State offices closed in observance of Martin Luther King Day
Tuesday
Florida Hospital Association’s Hospital Days.
1 p.m. — The House Health & Human Services Committee meets. Room 17, House Office Building.
1:30 p.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.
4 p.m. — The House Select Committee on Health Innovation meets. Room 17, House Office Building.
Wednesday
Day 2 of Florida Hospital Association’s Hospital Days.
8 a.m. — The House Healthcare Regulation Subcommittee meets. Room 102, House Office Building.
8:30 a.m. — The Senate Children Families and Seniors Committee meets. Room 37, Senate Office Building
10:30 a.m. — The House Appropriations Committee meets. Room 212, Knott Office Building.
11 a.m. — The Senate Appropriations Committee on Health and Human Services meets.
4 p.m. — The House is in Session.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
