Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Health care on Senate floor —
Senate President Kathleen Passidomo’s health care workforce overhaul known as “Live Healthy” is poised to pass the Florida Senate this week.
The two primary bills in the package are scheduled to be taken up by the Senate on Thursday and will soon be on their way to the House. The legislation (SB 7016 and SB 7018) was first rolled out in December and quickly moved through committee.
Combined, the bills would set aside nearly $1 billion as part of a comprehensive program designed to bolster the number of doctors and other health care professionals practicing in the state.
The fast action by the Senate comes as the House works on its version of Live Healthy, HB 1549 and HB 1501.
HB 1549 is about 200 pages shorter than SB 7016 and has about $200 million less funding, with the House including less money for provider rate increases and graduate medical education.
The House also hasn’t put money toward health innovation the way the Senate has. SB 7018 directs $75 million to the fund over a 10-year period. The House’s version of the innovation fund bill, HB 1501, doesn’t include any money. Instead, it notes that the revolving loan fund is “contingent upon appropriation by the Legislature.”
HB 1549 cleared the Select Committee on Health Innovation last week and HB 1501 passed the Healthcare Regulation Subcommittee. Both bills have two more stops before heading to the House floor.
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—The House omnibus health bill—
The House has trumpeted health care price transparency for the last decade and it’s no surprise it’s a large part of HB 1549.
The bill requires each licensed hospital and ambulatory surgical center (ASC) to post a consumer-friendly list of standard charges for at least 300 shoppable health care services on a facility website. A facility that provides fewer than 300 distinct services will be required to post standard charges for each service it provides.
HB 1549 requires facilities to post pricing information for shoppable services by the definition of “standard charges” established in the federal rule. For each shoppable service, a hospital must disclose the gross charge, the payer-specific negotiated charge, a de-identified minimum negotiated charge, a de-identified maximum negotiated charge, and the discounted cash price.
The provisions mirror the shoppable services requirement included in the hospital facility transparency regulations finalized by the federal Centers for Medicare & Medicaid Services in 2019.
The House bill also requires hospitals and ASCs to establish an internal grievance process that allows a patient to dispute any charges that appear on an itemized statement or bill.
HB 1549 updates debt collection exemptions for debt incurred as a result of medical services provided in hospitals, ambulatory surgical centers, or urgent care centers.
The bill increases from $1,000 to $10,000 the ceiling on the debt collection exemptions. It also increases from $4,000 to $10,000 interest in personal property, provided that a debtor does not claim the constitutional homestead exemption.
— FMA priorities —
It’s been more than 20 years since the Florida Legislature significantly tackled medical malpractice-related issues. The Legislature could consider the issue before the end of the 2024 Session, which runs through March 8, Florida Medical Association CEO Chris Clark told Florida Politics.
And it all hinges on an apparent quid pro quo.
“We have been in discussions with Clay Yarbrough and several others and we could live with a wrongful death bill if we could bring back the caps that were passed in 2003 that the court invalidated,” Clark said, referring to SB 248 filed by Yarbrough.
Yarbourgh’s bill eliminates Florida’s long-standing law that bans adult children from receiving non-economic damages in medical malpractice lawsuits involving the death of their parents. Florida law also bans parents from receiving non-economic damages in lawsuits involving the death of their adult children.
The caps Clark referenced were included in a 2003 medical malpractice bill. The caps were sliding based on the severity of the case and the provider being sued.
If the medical malpractice case was against a practitioner, there was a $500,000 damages cap per claimant. The cap increased to $1 million, regardless of the number of claimants, if the medical malpractice contributed to a permanent vegetative state or death. A court could also determine the malpractice was severe and resulted in severe non-economic harm allowing the cap to be raised to $1 million.
If the defendant was a hospital or facility the non-economic damages cap was $750,000 and increased to $1.5 million, regardless of the number of claimants, if the malpractice contributed to a permanent vegetative state or death. Again, the court could also increase the cap to $1.5 million if it determined the malpractice resulted in catastrophic injuries and severe non-economic harm.
The caps, though, were struck down in a series of Florida Supreme Court rulings and today there are no caps on non-economic damages in medical malpractice lawsuits.
The FMA would like to see that change.
“So we’re working on if there is a way of tying those two issues together, that the wrongful death bill could go, and we get some meaningful med-mal reform.”
Medical malpractice is one of many issues the FMA CEO has on his radar this Session.
The FMA also is pushing for the state to increase the Medicaid payments for participating physicians. The FMA wants the Medicaid rates paid to the doctors who care for the poor, elderly, and disabled to equal Medicare rates. That will require a total $483 million infusion, of which $206 million would be in state dollars and the remainder in federal matching funds. Gov. Ron DeSantis included additional Medicaid funding for doctors in his proposed legislative budget request.
“If you increase what you pay in Medicaid to Medicare levels, you’re gonna have more physicians, see those patients, and they’re gonna get quicker in to see them, instead of when you call to get an appointment and its eight months away,” Clark said.
— State group health insurance —
Florida economists have projected a small uptick in the number of state employees who are expected to enroll in the state health insurance program this year and in the next several years.
While the increased enrollment number is not large, it adds to the financial pressure being placed on the $3 billion-a-year state group health insurance plan. State legislators last year poured in more than $322 million in extra funding to help keep the insurance trust fund from running a deficit.
The latest estimates forecast more than 170,000 state workers will receive coverage during the current fiscal year, which ends June 30 — and that the total will continue to rise by about 1,700 additional workers each year between 2024 and 2027.
How that will impact the bottom line has not yet been released by state economists but that figure will be available by the time the House and Senate budget committees release their proposed spending plans for the 2024-25 fiscal year.
Last August the forecast showed that the state insurance trust fund was projected to have a $348 million deficit by the summer of 2025. The deficit projection will likely grow given that the overall number of employees receiving coverage has grown.
The ongoing financial stress could theoretically prompt state legislators to increase the premiums charged to state workers. But for years legislators have kept the rates constant and have not increased the premiums. Instead, the Legislature has increased the amount paid into the trust fund from state tax dollars.
Rank-and-file state workers pay $50 a month for individual coverage and $180 a month for family coverage. State workers in management and senior positions, as well as legislative employees, pay $8.34 a month for individual coverage and $30 for family coverage.
— Hello LeadingAge Southeast —
LeadingAge Florida completed its merger with LeadingAge Gulf States, bringing the organizations together to serve senior living providers across Florida, Alabama, Louisiana and Mississippi.
The new regional association now includes 350 mission-driven members that represent more than 600 facilities across four states. Those mission-driven communities provide care to more than 80,000 older adults
LeadingAge Florida will continue to be headquartered in Tallahassee but operate under a new name and brand — LeadingAge Southeast.
“We are thrilled to welcome our newest members to the association,” said Steve Bahmer, LeadingAge Southeast President and CEO. “A growing population of older adults means a greater need for a robust portfolio of high-quality retirement options. Supporting those options and ensuring these older adults have the services and supports they need has been our legacy in Florida, and it will be our singular focus as LeadingAge Southeast as well.”
Garry Hennis, COO of Westminster Communities of Florida, and Chair of the LeadingAge Southeast Board of Trustees, said the merger is an opportunity to continue the association’s strategy of mission amplification and to extend its education and advocacy efforts to more providers.
“Senior living providers are pursuing affiliations to help providers continue to serve older adults through greater scale and resources, and associations are pursuing similar strategies for the same reasons,” he said. “We are excited to welcome our new members from the neighboring states and extend to them the collaboration and support that are at the very heart of our mission.”
—RULES—
The Board of Nursing proposes amending Rule 64B9-15.005 regarding the standards outlined in the rule for certified nursing assistant training programs. More here.
The Board of Nursing proposes developing Rule 64B9-16.003 regarding competency and knowledge requirements necessary to qualify a licensed practical nurse to supervise in nursing home facilities. More here.
The Board of Nursing proposes amending Rules 64B9-14.0016, 64B9-14.002, and 64B9-14.003 regarding the delegation of tasks to unlicensed personnel. More here.
The Board of Nursing proposes amending Rule 64B9-14.0015 regarding delegating tasks to unlicensed assisted personnel. More here.
The Board of Nursing proposes amending Rule 64B9-15.001 64B9-16.002 and 64B9-16.004 regarding delegating tasks to unlicensed assisted personnel. More here.
The Board of Nursing proposes amending Rule 64B9-16.001 regarding delegating tasks to unlicensed assisted personnel. More here.
The Board of Medicine proposes amending Rule 64B8-4.025 regarding licensure under supervision to require that a supervisor be board-certified in the applicant’s specialty area. More here.
The Office of Medical Marijuana Use published emergency rule 64ER24-1 regarding MMTC Seed-to-Sale Tracking System Integration. More here.
The Office of Medical Marijuana Use published emergency rule 64ER24-2 regarding MMTC Seed-to-Sale tracking system procedures. More here.
— LOBBYISTS —
Michael Fischer, The Aegis Group: American Cancer Society Cancer Action Network and its Affiliates, and Florida Independent Pharmacy Network
Haley Tobias, GA McKeown & Associates: American Cancer Society Cancer Action Network and its Affiliates
Dawn Briggs White, Baptist Health South Florida
Melody Selis Arnold, Edward Briggs, Matthew Herndon, Natalie King, RSA Consulting Group: American Medical Response, Moffitt Cancer Center, Treasure Coast Community Health
Tretyn Fenske, Patrick Steele: Agency for Health Care Administration
Julie Fess, Gunster Yoakley & Stewart: CDx Diagnostics
—ETC—
— The House Insurance & Banking Subcommittee is considering legislation, HB 637, that increases the amount specialists can be reimbursed in the worker’s compensation system. Currently, specialists are reimbursed at 110% of Medicare rates. The legislation increases that to 200% of Medicare rates. The bill also permits certain firefighters, law enforcement officers, correctional officers, or correctional probation officers seeking medical treatment under the worker’s compensation system for certain presumptive conditions to seek treatment from a medical specialist.
— Access to health care is a top priority for the Florida Legislature this Session. Florida Politics spoke with Florida Hospital Association Trustee, President and CEO Michael Mayo, DHA, about the top health care needs in Northeast Florida and throughout the state. See the interview in the Jan. 15 edition of Last Call.
— The Agency for Health Care Administration, received a petition for Variance from or Waiver of Florida Administrative Code Rules 59G-4.261 and 59G-4.215 (“Petition”), on behalf of the Petitioner, R.B. and of Rule 59G-4.215, F.A.C. Rule 59G-4.261, F.A.C., contains the Florida Medicaid Private Duty Nursing Services Coverage Policy and applies to all providers rendering private duty nursing services to Medicaid recipients. The petition requests a permanent waiver of or variance from the limitation contained in Section 5.2 of the coverage policy that restricts otherwise qualified family members from being reimbursed by Medicaid for providing services to a Medicaid recipient who is a relative, as defined by Section 429.02(18), F.S. More here.
—ROSTER—
— HCA Florida Northside Hospital has named Jabr Hadid, MD, chief medical officer. Hadid previously worked at HealthFirst, where he served as a physician advisor in Melbourne. Prior to HealthFirst, he was the lead hospitalist at Holmes Regional Medical Center in Melbourne, in private practice and as a hospitalist program medical director at Union Hospital in Dover, Ohio.
— Thomas “Zach” Orr has been appointed the new Assistant Director of the West Palm Beach VA Healthcare System (WPBVAHCS). Orr joined the Department of Veterans Affairs in 2018.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
Industry mandates — A House health care panel passed four bills that collectively put mandates on hospitals, ambulatory surgical centers, insurers and managed care plans. More here.
Vote on two nursing bills deferred — The House Healthcare Regulation Committee deferred votes on two bills that would have given certain advanced nurses more autonomy in the health care marketplace. Rep. Webster Barnaby asked that a vote on his bill (HB 771) to allow about 1,100 certified psychiatric nurses to practice autonomously be deferred after committee members asked him several questions that he was unable to answer. After Barnaby requested that a vote be deferred, Healthcare Regulation Committee Chairman Rep. Michelle Salzman announced the committee also would not consider HB 257 but she did not explain. More here.
Third report — AARP Florida continues to express concerns over the quality of care provided to nursing home residents in Florida, releasing a new report showing that hospitalizations for short-stay residents increased after the Legislature agreed to lower the number of nursing hours residents were required to receive. More here.
Thinking ahead —Lecanto Republican Rep. Ralph Massullo wants to place strict limits on THC content in recreational cannabis which would thwart the impact of the proposed constitutional amendment on recreational marijuana. THC, short for tetrahydrocannabinol, is the compound contained in cannabis that produces a high. Massullo’s bill, HB 1269, would cap THC content at 10% for smokable marijuana, including whole flower, and place a 60% limit for non-smokeable cannabis, such as vaporizer cartridges. Additionally, the bill would limit edibles to 200 milligrams per package with no more than 10 milligrams of THC in a “single serving portion.” More here.
That was quick — A pair of health care bills prioritized by Passidomo designed to expand the state’s health care workforce and access to mental health services cleared their last committee vote and are now headed to the Senate floor. The Senate Fiscal Policy Committee approved SB 7016 and SB 7018 unanimously after Republicans waved off an attempt by Democrats to tack on an amendment to expand Medicaid to one of the bills. More here.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Donald Trump official who OK’d drugs From Canada chairs company behind Florida’s import plan” via Phil Galewitz of KFF Health News — The Food and Drug Administration’s unprecedented approval of Florida’s plan to import drugs from Canada was made possible only after Alex Azar, as the Trump administration’s Health and Human Services secretary, certified that bringing medicines over the border could be done safely. Azar made the historic declaration in September 2020, just two months before his boss, Trump, lost reelection. Now, Azar’s involved in the business of making importation happen. He is chairman of the board of LifeScience Logistics, a Dallas-based company that Florida is paying as much as $39 million to help manage its Canadian drug importation program.
“Former Sarasota Chamber CEO files to run for seat on Sarasota County Public Hospital Board” via the Sarasota Herald-Tribune — Kevin Cooper, a former Army sergeant and current vice president for communications and strategic initiative at Mote Marine Laboratory and Aquarium, recently filed paperwork to run for Seat 2 on the Sarasota County Public Hospital Board. Hospital Board Chair Tramm Hudson, the current occupant of that at-large seat, does not plan to seek another term. He has been on the Board since 2015. There will be three other hospital Board seats up for election this year in Sarasota County — Central District Seat 1, occupied by Sarah Lodge; At large Seat 1, occupied by Sharon Wetzler DePeters; and at large Seat 3 occupied by Britt Riner.
“Billions of dollars at stake as Florida prepares to pick Medicaid winners and losers” via Brian Burgess of The Capitolist — Florida’s top health care regulators at the state’s Agency for Health Care Administration have their hands full as they sift through a long list of major decisions and policy changes expected to take place this year. The agency is already tasked with picking winners and losers in the Medicaid managed care system with billions of dollars on the line. But on Friday, the Live Healthy Act made more progress through the Florida Legislature, passing a key Committee hurdle with the backing of Senate President Passidomo. The bill could bring even more changes than are already on the way to the state’s massive health care system with a strategic overhaul of state health care regulations, policies and practices.
“Rep. Berny Jacques bill establishing pregnancy resource hub unanimously passes House Committee” via Owen Girard of Florida’s Voice — Legislation by Rep. Jacques establishing an online pregnancy resource hub unanimously passed the Florida House Healthcare Regulation Subcommittee on Thursday. Sen. Erin Grall filed the Senate companion bill, SB 436. The Florida Department of Health would contract with a third party to develop the site. “This website will contain critical resources for expecting parents and pregnant women,” Jacques said during Committee. “These services would include education materials on pregnancy and parenting, maternal health services, prenatal and postnatal services, educational and mentorship programs for fathers, social services, financial assistance and adoption services.”
— PENCIL IT IN —
Thursday
It’s CRNA Day at the Capitol.
The Florida Commission for the Transportation Disadvantaged will be in the Capitol courtyard.
9 a.m. — The Senate is in Session and will consider the Live Healthy Proposal, SB 7016 and SB 7018. The Special Order Calendar is here.
12:30 p.m. — The House Health Care Appropriations Subcommittee meets. The committee will consider HB 99 regarding social work licensure Interstate Compact; HB 115 regarding progressive supranuclear palsy and other neurodegenerative diseases policy workgroup; and HB 197 regarding the Department of Health and regulation of massage therapy establishments. Room 17, House Office Building.
3 p.m. — The House is in Session.
Friday
4 p.m. — The House Children Families and Seniors Subcommittee meets. Room 102, House Office Building.
Monday
12 p.m. — The House Appropriations Committee meets. Room 212, Knott Building.
3 p.m. — The House Select Committee on Health Innovation meets. Room 17, House Office Building.
Tuesday
8:30 a.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.
12:30 p.m. — The House Health & Human Services Committee meets. Room 17, House Office Building.
1 p.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.
3 p.m. — The House is in Session.
3:30 p.m. — The Senate Children, Families and Elder Affairs Committee meets. Room 37, Senate Office Building.
Wednesday
It’s Moffitt Day at the Capitol.
8 a.m. — The House Healthcare Regulation Subcommittee meets. Room 102, House Office Building.
8:30 a.m. — The Senate Appropriations Committee meets. Room 110, Senate Office Building.
11 a.m. — The House Children Families and Seniors Subcommittee meets. Room 102, House Office Building.
1:30 p.m. — The House Health Care Appropriations Subcommittee meets. Room 17, House Office Building.
2 p.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.
3 p.m.— The Florida Trauma System Advisory Council meets virtually. No vote will be taken. Microsoft Teams, Meeting ID: 259 305 072 35 Passcode: BdRpYL. Video Conference ID: 116 715 633 9. Attendees can also call (850)792-1375; participant code: 724879702#
4 p.m. — The House is in Session.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
