Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Florida faculty and other employees who work at one of Florida’s 28 state colleges could soon be allowed to enroll in the same health insurance program used by rank-and-file state workers.
The Senate is backing the move in its proposed spending plan for fiscal year 2024-25 and the Senate Appropriations Committee on Wednesday voted for the change as part of an education budget bill (SPB 2516). Faculty and employees who work at state universities are already part of the state group health insurance program.
“We think it’s a fairness issue,” said Senate Budget Chief Doug Broxson, pointing out that state colleges have been asked to be treated the same as state universities. “We will put it in the budget and see if we can negotiate with the House to do what is good policy.”
The bill would let state colleges apply to join the state group insurance program by Aug. 1 and enrollment of employees would have to begin before July 31, 2025.
The House does not have a similar proposal and the inclusion of college employees will be one of the items that will need to be hashed out between the chambers during budget negotiations in the final month of the Session.
Rep. Tom Leek, the House Appropriations Committee Chair, said he is open to discussing the concept with the Senate but that he is concerned about the overall solvency of the state group health insurance program. Leek said he has seen estimates that adding state college employees could cost anywhere from $80 million — which is how much money the Senate set aside for the change — to $380 million.
“We have to hone in on how they got their calculation there and then we can see what can be done,” Leek said.
Florida currently spends about $3 billion on the state group health insurance program, with most of the cost being picked up by the state and not from employee premiums. Legislators for the last two years put extra money in the trust fund due to projected deficits and they could put even more money into the fund in the 2024-25 budget. Neither the House nor the Senate has proposed raising health insurance premiums paid by state employees and others covered by the plan, including legislators.
The health insurance proposal is part of the Senate’s proposed $116 billion spending plan for FY 2024-25 contained in SB 2500, which cleared the Appropriations Committee unanimously Wednesday. The Senate spending plan directs $45.96 billion in health care spending across the state’s various health care agencies of which nearly $15.84 billion is in state dollars.
The House Appropriations Committee also passed its proposed $115.5 billion budget for FY 2024-25, contained in PCB APC. It also was passed with unanimous support. The House budget proposes spending $45.98 billion on health care services, with nearly $15.83 billion coming from state tax dollars.
While the proposed spending plans contain billions in spending across the state’s various health care agencies, the House and Senate have included hundreds of millions dollars in their respective proposals to fortify Florida’s health care workforce in the coming years by increasing graduate medical education opportunities and increasing Medicaid reimbursement rates for hospitals and physicians.
The Senate’s “Live Healthy” proposal (SB 7016) contains a $717 million-plus appropriation, whereas the House companion (HB 1549) has a $548.6 million appropriation.
House and Senate lawmakers named to the health care budget conference committee will attempt to hammer out the differences in the chambers’ health care spending plans later this Session. There will be no committee, though, to settle the spending differences in the Live Healthy proposals.
I welcome your feedback, questions and especially your tips. You can email me at [email protected] or call me at 850-251-2317.
—The grass is always greener—
The assisted living facilities industry says it wants to be treated more like nursing homes when it comes to civil lawsuits and is supporting SB 238, filed by Sen. Colleen Burton.
Burton’s bill, which passed the Senate Judiciary Committee on Monday, would change ALF statutes so that “passive investors” could not be named as defendants in civil litigation. The definition of passive investor is identical to the definition used in the nursing home statutes.
Robin Khanal, an Orlando defense lawyer with 20 years of experience defending long-term care providers from litigation, told senators that ALFs need the same legal safeguards that nursing homes enjoy.
“I can go into court now and defend nursing homes that have these safeguards and you don’t get 20 defendants in a lawsuit. Unfortunately, because these safeguards do not exist, I got into an ALF case and there is a plethora, a large list, of defendants. And all we are asking for are the same procedural safeguards that the nursing homes get as to who can be named and when,” he said.
There is no effort by the nursing home industry in the 2024 Session to limit lawsuits. The push for ALFs to be treated like nursing homes ironically comes after nursing homes during the 2023 Session pushed to be treated the same as hospitals and doctors for medical malpractice-related wrongful death cases. Burton filed the legislation to do just that but SB 1304 died without being considered.
ALFs are establishments that provide housing, meals and one or more personal services, for periods exceeding 24 hours, to one or more adults who are not relatives of the owner or the administrator. There are approximately 3,000 licensed ALFs in the state today with a combined 106,000 beds. Residents residing in ALFs are guaranteed certain rights.
Nursing home residents also have guaranteed rights. There are 691 licensed nursing homes in Florida. Nursing homes provide 24-hour-a-day nursing care, case management, health monitoring, personal care, meals, physical, occupational, and speech therapy, social activities, and respite care for the state’s most frail residents.
—Quietly, a good deal—
Rep. Fiona McFarland thinks this is the year the Legislature makes changes to the often-criticized claims bill process by passing legislation that doubles the current sovereign immunity limits.
The House Appropriations Committee passed McFarland’s HB 569 Monday. The Senate Governmental Oversight and Accountability Committee passed the companion measure, SB 472 by Sen. Jason Brodeur, with a 5-1 vote the same day. The bills are similar but not identical.
The state’s sovereign immunity limits place a cap on how much a family or individual can get paid even if a jury awards a much higher amount or a settlement is reached. To get paid an amount above the cap, the Legislature must approve a claims bill, which often is a contentious and heavily lobbied practice.
Many legislators have refused to sign off or vote for any claims bills, contending that the process is flawed and too dependent on lobbyists. But other legislative leaders have pushed ahead by saying the government owed it to those wronged to pay off the claims.
Before agreeing to pass HB 569 the House Appropriations Committee tagged an amendment onto the bill that eliminated the requirement for the Department of Financial Services (DFS) to automatically adjust the statutory caps in accordance with the Consumer Price Index (CPI) on an annual basis. McFarland said the requirement was too complicated.
By doubling the current sovereign immunity caps, the bills increase costs for local governments and government agencies, including hospitals. The bills were passed by the House and Senate panels as the Florida League of Cities held its annual Legislative Action Days at the Capitol.
“It was not the greatest day to be on the agenda,” McFarland told Florida Politics half-jokingly. “I mean, it’s a financial burden for the cities and the counties and the sovereigns; of course it is. So, I don’t think there is any universe in which they support the bill. Quietly they’ve admitted that this is a pretty good deal.”
The bills also abolish home venue privilege, thereby allowing a claimant to bring a suit against the state, its agency, or a subdivision thereof in the claimant’s home county, the county where the action accrued, or the county in which the property in litigation is located.
—FDA’s 2024 legislative priorities—
Florida Dental Association (FDA) members and executives were all smiles this afternoon after one of their priority bills, SB 302, filed by Sen. Jim Boyd, passed the Senate Fiscal Policy Committee witth unanimous support.’
The vote comes on the heels of FDA’s Dentist Day at the Capitol. SB 302 puts in place requirements to practice dentistry via telehealth and it’s one of several priorities the FDA has for the 2024 Session.
The FDA, similar to the Florida Hospital Association (FHA) and the Florida Medical Association (FMA) says state insurance code needs to be updated and requirements made to ensure carriers are covering services that have received prior authorization.
“This is an important issue to the Florida Dental Association because we have run into patients who have dental insurance or dental benefits,” FDA President and Miami periodontist Dr. Beatriz Terry. “As a dentist — as a private practitioner — we submit for pre-authorization to get coverage to get approval for the treatment that we want to provide our patients. We get a letter back saying that the treatment has been approved but in small print, it says ‘not guarantee of payment, and the procedures performed.’ And then when we submit for payment on a pre-authorized procedure, they have denied coverage.”
The bill also prohibits insurers, prepaid limited plans and HMOs from including in their provider contracts language that requires dentists to accept Automated Clearing House (ACH) or electronic payments and to pay the associated costs. Terry said contracts with insurance companies and other payors require dentists to actively opt out of the ACH payments. The FDA would like to change that so dentists would be required to opt in for ACH payments.
For the FDA, the fix is in SB 892/HB 1219.
Increasing Medicaid reimbursements for participating dentists also is a top priority for the FDA and it appears to be coming to fruition with House and Senate “Live Healthy” proposals raising reimbursement rates by $35 million.
Terry said it’s been more than a decade since lawmakers increased payments to dentists. Florida, she said, is ranked in the bottom 10% of states for its low dental reimbursement rates.
“We really need the funding so that we can have more Medicaid providers. The difficulty with getting Medicaid providers is that the compensation is too poor. And so this increase would allow for more people to participate in the program and give, you know, access to care, a boost.”
The FDA also has partnered with the state Department of Veterans’ Affairs to get funds for the Florida’s Veterans Dental Care Grant. It was created in statute in 2023 but not funded. Veterans’ Affairs included $3 million in its proposed legislative budget request to fund the program.
Additionally, the FDA is seeking financial support for its two-day Mission of Mercy clinics.
—Scope battle updates—
While the FDA is advocating on behalf of several issues, it also is working to defeat an effort by the Florida Dental Hygienists Association, the Florida Association of Community Health Centers, and the American Children’s campaign, among others, to establish licensure criteria for dental therapists.
While a House health care subcommittee passed HB 1173 by a 14-3 vote on Jan. 24, the Senate companion measure, SB 1254, has been referred to three Senate panels and to date has been heard by none.
The debate over the establishment of the new dental licensure category is but one example of the scope of practice fights that routinely occur in the halls of the Capitol. Former Senate President Don Gaetz once referred to a battle between ophthalmologists and optometrists as the “eyeball wars.”
There also are the “sleep wars.” The Florida Association of Nurse Anesthetists wants the Legislature to authorize autonomous certified registered nurse anesthetists (CRNAs) to administer anesthetic without an established supervisory protocol with a physician. The House Healthcare Regulation Subcommittee deferred action on HB 257 and the bill isn’t listed on the panel’s agenda for its Thursday meeting. The Senate companion bill hasn’t been heard to date.
And the Florida Society of Anesthesiologists (FSA) is probably a reason why. It’s Physician Anesthesiologists Week, an opportunity for the association to focus on advocacy and outreach efforts that promote anesthesiologists as “uniquely qualified” to lead the patient care team.
As part of the week-long event, FSA launched a digital campaign in the Tallahassee market. The flight includes 15-second and 30-second pre-roll ads emphasizing that “physician-led anesthesia care is the safest, most cost-effective model of anesthesia medicine.”
There also has been disagreement in recent years over bills that establish in statutes the titles that health care practitioners can use to refer to themselves in advertisements. The issue is a priority for Passidomo, whose father was an ophthalmologist. While Passidomo secured passage in the 2023 Session Gov. Ron DeSantis vetoed SB 230.
The issue is back in the 2024 Session. SB 1112 cleared the Senate Health Policy Committee Tuesday. HB 1195 will be taken up by the Healthcare Regulation Committee on Thursday.
Not all scope debates, though, are limited to individuals and there is a scope of practice debate in the House and Senate Live Healthy proposals. The bills establish what are known as “advanced birthing centers” (ABCs) which would be authorized to perform cesarean sections. Hospitals oppose the creation of ABCs.
—RULES—
The Board of Orthotists and Prosthetists proposes amending Rule 64B14-3.001 regarding definitions.
—LOBBYISTS—
Joshua Aubuchon, Delegal Aubuchon Consulting: Capital Health Plan
Slater Bayliss, Christopher Chaney, The Advocacy Partners: Precision Healthcare
Sara Clements, Rhett O’Doski, Ryder Rudd, Sean Stafford, McGuireWoods Consulting: Lightshare Behavioral Wellness & Recovery
Patsy Eccles: Florida School for the Deaf and the Blind
Anna Lewis, Metz Husband & Daughton: SMA Healthcare
Melissa Meshil: HCA Healthcare
John Ray, John Ray Consulting: Florida Medical Manufacturers’ Consortium
—ETC—
—The Biden-Harris Administration announced Wednesday that sickle cell disease (SCD) will be the first focus of the Cell and Gene Therapy (CGT) Access Model, which was initially announced in February 2023. The CGT model is designed to improve health outcomes, increase access to cell and gene therapies, and lower health care costs for some of the nation’s most vulnerable populations.Sickle cell disease is an extremely painful condition, which disproportionately impacts Black Americans and has had limited treatment options. In the United States, more than 100,000 people live with SCD. Individuals with the disease have a shorter life expectancy, by more than 20 years, compared to someone living without SCD.
—Feb. 1 marks American Heart Month. More than 120 million Americans live with a cardiovascular condition.
—Feb. 3 is National Women Physicians Day American Community Survey data show that in 2022 full-time year-round civilian employed female population 16 and shows there were 3,483 emergency medical physicians, 3,886 radiologists, and 291,655 “other” physicians who are female.
—ROSTER—
—Barry Issenberg, M.D., director of the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami Miller School of Medicine, has been named the 2024-25 President of the Society for Simulation in Healthcare.
—Three new members have been named to the Health Foundation of South Florida board of directors: Alfred G. Battle Jr., David J. Clark and Alexander M. Fernandez. Battle is the Deputy Director of the Development Services Department in the City of Fort Lauderdale. Clark is the Senior Vice president of operations at Broward Health System. Fernandez is the executive vice president and CFO VITAS Healthcare, the nation’s leading provider of end-of-life care.
—ICYMI—
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Brazilian butt lift bill clears House health care spending panel” via Christine Jordan Sexton of Florida Politics — Lawmakers appear to be knee-deep in ass once again this year. A House health care spending panel unanimously approved a bill (HB 1561) that closes loopholes in a statute regulating Brazilian butt lifts (BBLs) that was passed last year.
“Ban on out-of-pocket charges for breast exams clears first Senate hurdle” via Jesse Scheckner Florida Politics — The Senate Banking and Insurance Committee passed legislation this week that changes the law regarding patient cost-sharing requirements to ban insurance companies from charging what Sen. Lori Berman said are cost-prohibitive copays for diagnostic and supplemental breast exams. Berman is a breast cancer survivor and sponsor of SB 932.
“House panel advances hemp restrictions with alt-cannabinoids ban, THC cap” via A.G. Gancarski Florida Politics— The House Agriculture, Conservation and Resiliency Subcommittee passed a bill that would crack down on alternative cannabinoids and impose new restrictions on delta-9 THC in hemp, bringing massive changes to the multibillion-dollar industry. HB 1613 changes the statutory definition of hemp and despite public testimony derailing the bill as “discriminatory,” and a “witch hunt,” it easily cleared the subcommittee.
“Abortion amendment could boost Democrats in November” via A.G. Gancarski Florida Politics—Floridians Protecting Freedom said their bid to have adult reproductive rights enshrined in the Constitution will be Amendment 4 on the 2024 ballot. The abortion rights referendum, if it survives court scrutiny and earns at least 60% support in the November 2024 election, would prohibit any law limiting the ability to obtain an abortion before fetal viability — generally between 20 and 25 weeks into a term — or if an abortion is “necessary to protect the patient’s health, as determined by the patient’s health care provider.”
“Aligning registries” via Jacob Ogles Florida Politics — The Veterans Administration retains a cancer registry separate from state databases. But Miramar Democratic U.S. Rep. Sheila Cherfilus-McCormick said patients in the VA system would be better off if there was more data shared between agencies. And she’s working across the aisle to get it done. Cherfilus-McCormick introduced the Counting Veterans’ Cancer Act with U.S. Rep. Jen Kiggans, a Virginia Republican. Cherfilus-McCormick is the ranking Democrat on the House Veterans Affairs Technology Modernization Subcommittee, which Kiggans chairs. In addition to the VA and states sharing registries, the bill also calls for the Centers for Disease Control and Prevention to serve as a go-between to ensure compliance.
—FOR YOUR RADAR—
Aside from coverage by Florida Politics, these stories are worth your time.
“7,000 women traveled to Florida for abortions in 2023. Key court rulings could soon end those journeys.” via Caroline Catherman of the Orlando Sentinel — In total, one out of 10 of Florida’s 78,250 recorded abortions last year was done on an out-of-state resident, according to Florida Agency for Health Care Administration data released in early January. The number of total abortions shrank by about 4,000 compared with 2022 but out-of-state residents getting the procedure increased by over 400. As the Florida Supreme Court contemplates the constitutionality of the state’s currently active 15-week ban, a pending six-week ban, and a proposed constitutional amendment to enshrine abortion access in the state’s constitution, these numbers are a reminder that the future of abortion in Florida could affect the entire Southeast.
“Medical experts: Senate bill increasing penalty for fentanyl exposure ‘unnecessary‘” via Ana Goñi-Lessan of The Palm Beach Post — Bodycam footage of police officers collapsing at traffic stops after they say they were exposed to fentanyl have gone viral and now are the catalyst for a new bill, even though medical experts say the potential legislation could harm someone experiencing an overdose. Exposures of First Responders to Fentanyl (SB 718/HB 231), which passed through a Senate Criminal Justice Committee meeting Tuesday, would make it a second-degree felony to “recklessly” expose a first responder to fentanyl or any fentanyl analogues (drugs that are chemically similar), resulting in bodily injury. “It’s a problem. You can get exposed to it,” said bill sponsor Sen. Jay Collins. “The pre(cursor) chemicals, the aerosolization of those things that you can walk right into, touching someone and rubbing your eye and going down — people have to be held accountable for this.”
“UCF’s new nursing school facility hopes to combat nursing shortage” via Celeste Springer Spectrum News 13 — Construction is underway on a brand new UCF facility aimed to train the next generation of nurses. University officials say it will be a state-of-the-art facility, but they’re also hoping to combat a nationwide issue of nursing shortages.
“Department of Health officials focus on fight against diabetes in Sarasota County” via Sarah Owens of the Sarasota Herald-Tribune — More than a year into a five-year plan that identifies diabetes as one of Sarasota County’s top medical concerns, local health authorities have laid the foundations for improvements in education, prevention and treatment in key county hot spots. Among the components of the Sarasota County Department of Health’s Health Equity Plan are descriptions on the seriousness of diabetes, who it most affects, the condition’s contributing factors and recommendations on how to better treat patients and reduce the rate of new cases. Health disparity data in the county identified HIV, diabetes and asthma as the top three local medical concerns.
— PENCIL IT IN —
Thursday
10 a.m. — Florida Decides Healthcare hosts a virtual press conference to announce the kickoff of petition collection for a ballot initiative for the 2026 general election to expand Medicaid access to adults as allowable under the federal law known as Obamacare. Register for the press conference here.
11:30 a.m. — The House Healthcare Regulation Subcommittee meets. Included on the agenda is HB 1295 regarding health care practitioner titles, and HB 1435, capping the potency of medical marijuana and banning synthetic marijuana. Room 102, HOB.
Noon — The Senate is in session.
3 p.m. — The House is in session.
Friday
9 a.m. — The Senate is in session.
9 a.m. — The Select Committee on Health Innovation meets. Room 17, HOB.
Noon — The House is in session.
Monday
2:30 p.m. — The Senate Judiciary Committee meets. Room 412, Knott Building.
Tuesday
Happy birthday to Sen. Clay Yarborough.
8:30 a.m. — The Senate Children, Families, and Elder Affairs Committee meets. Room 37, SOB.
11:30 a.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.
12:30 p.m. — The House Health Care Appropriations Subcommittee meets. Room 17, HOB.
Wednesday
9 a.m. — The Senate is in session.
9 a.m. — The Florida Supreme Court considers SC2023-1392 Advisory Opinion to the Attorney General re: Limiting Government Interference with Abortion.
10:30 a.m. — The House Judiciary Committee meets. Room 404, HOB.
2 p.m.— The House is in session.
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
