Diagnosis 2.7.24: 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.

—Budget time —

State legislators are about to head into one of the most consequential periods of Session: Budget negotiations.

The House and Senate are expected to pass their budget bills on Thursday and then begin the behind-the-scenes work to figure out how much money legislative leaders will set aside for the budget and other budget-related legislation.

Senate President Kathleen Passidomo said she anticipates that she will have “collegial” discussions with House Speaker Paul Renner about allocations — the top-line numbers that set the stage for the budget. Passidomo also predicted that the budget work and session will end “on time.” To end the Session on March 8, legislators must have the budget finished on March 5.

Once allocations are settled, House and Senate budget committees will work in tandem on all of the other differences in their rival $115 billion budget bills.

One key health care spending item, however, has already been worked out and that’s the amount of money that will be set aside in the separate “Live Healthy” legislation that’s designed to boost the number of health care professionals working in the state.

Heading into the budget conference there are some other notable differences, including a decision by the Senate to open up Florida’s state worker health insurance plan to employees at state colleges. The Senate has also set aside $80 million to help pay for the new enrollees. The House budget does not include this.

The House budget also includes a $123.9 million increase to Florida’s nursing centers and their residents. That’s a 4% hike in Medicaid reimbursement.

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

—Abortion arguments —

In what may have been a bit of surprise, some of the conservative justices on the Florida Supreme Court sounded somewhat skeptical about blocking a proposed abortion rights amendment from the 2024 ballot.

Nearly a million voters signed petitions in order to get the amendment — which would protect abortion up to the point of viability — on the ballot. But the high court has to review the amendment to ensure it sticks to a single subject and that the ballot summary is not misleading.

Attorney General Ashley Moody has asserted that the amendment could confuse voters, but the argument didn’t resonate with several justices during oral arguments held Wednesday.

Chief Justice Carlos Muñiz, who was appointed by Gov. Ron DeSantis, disagreed with lawyers representing Moody that the purpose of the proposed amendment was being kept from voters.

“It’s pretty obvious that this is a pretty aggressive, comprehensive approach to dealing with this issue,” Muñiz said, adding, “this doesn’t seem like this is trying to be deceptive.”

Justice John Couriel did question Courtney Brewer, the attorney representing Floridians Protecting Freedom, on whether the scope of the amendment would restrict the ability of the state to regulate abortion providers for health and safety reasons. Brewer asserted that health and safety regulations could remain intact.

Meanwhile, Justice Meredith Sasso asked whether voters understood the definition of viability and Justice Renatha Francis argued that the amendment could enshrine a right to abortion for “the entire 9 months” since the language allows abortions past viability for health reasons.

Brewer pushed back on Francis’ logic: “I don’t know how an amendment could better communicate its chief purpose.”

The court’s review of the proposed amendment comes as justices are still considering whether the state’s existing 15-week abortion ban is constitutional. The Governor signed the ban into law in 2022, but then the Legislature in 2023 enacted a six-week ban. The six-week ban does not take effect unless the high court upholds the 15-week ban. Groups challenged the law on the grounds that it violates Florida privacy rights that were added to the state constitution in 1980.

—Minority reports —

Senate Democratic Leader Lauren Book attended the oral arguments.

A Democrat from Davie, Book said in a statement: “Today we witnessed anti-choice leaders launch their final, desperate attempt to keep abortion off the ballot this November. Instead of allowing abortion rights to play out democratically, the Attorney General and anti-choice extremists do not want Florida voters to have a say on Amendment 4 — not because the amendment language is unclear, but because the overwhelming majority of voters, Democrats, Republicans, and Independents alike, support abortion rights.

“We know the language used in Amendment 4 is clear and precise in limiting government interference with abortion before viability. I believe the Florida Supreme Court will do what is right, clearing the way for Florida voters to defend reproductive freedom and abortion rights by passing Amendment 4 this November.”

House Minority Leader Fentrice Driskell also issued a statement.

“Today, the lawyers for the ‘Yes on 4’ campaign showed that the language absolutely meets the requirements in law,” she said. “This amendment is ready for the voters of Florida. The Florida Supreme Court should stay in the very narrow lane our constitution gives them and not interfere with the people’s amendment process.

“Over a million Floridians signed the petition because they believe in a woman’s right to make her own health care decisions without political interference. The majority of Floridians want to keep abortion protected, safe, and legal but extremist politicians want to outlaw it.

“Let me be clear: Floridians from across the political spectrum did the work to get this on the ballot, and if they take away our right to have our voices heard: Florida will be furious. In state after state, in places like Kentucky, Kansas, and Ohio, the people have spoken up against out-of-touch extremist politicians and demanded their access to abortions be protected.

“Here in Florida, they know that the only way to avoid another defeat, and stop the will of the people, is with a procedural move like this. Florida will be watching, and the people will remember who stood with us, and who tried to silence us because they were afraid of our voices.”

—Prickly conversation —

Chiropractors’ effort to get the green light to “dry needle” was met with a somewhat prickly response this week.

Members of the Senate Health Policy Committee debated SB 1474 at length before voting 9-1 to pass the bill.

Filed by Sen. Jay Trumbull, the bill expands chiropractors’ scope of practice by authorizing them to perform dry needling, a technique that involves inserting thin needles into or near trigger points in the muscle to relieve pain and improve range of motion. The bill also creates a licensure pathway for chiropractic physicians who obtained their bachelor’s degree outside the United States to practice in Florida.

The provision would allow Amanda Sellers, a chiropractor from Longwood, to set up shop. Sellers, who started to cry during her testimony, said there were “many others” facing similar challenges.

Sellers received her undergraduate degree from the University of West Ontario Canada and subsequently went to chiropractic college in Florida in 2016. After graduating and passing her boards she moved to Reno, Nev., where she practiced until she and her husband decided to return to Florida to be closer to family.

But when she submitted her licensure application to the Florida Chiropractic Board this year, she was denied. She said she was told by the board at a Nov. 9, 2023, meeting that she would have to go back to college and receive her undergraduate degree.

Committee members were sympathetic with Sellers’ predicament. More than one committee member was irked, though, that the dry-needling issue was co-mingled with the fix for the Florida chiropractor.

“There are two really large concepts here, both with weight of (their) own. Why did you combine this in one piece of legislation?” Sen. Tracie Davis asked Florida Chiropractic Association (FCA) General Counsel Kimberly Driggers.

“Because the Board of Chiropractic Medicine asked us to fix it in a chiropractic bill,” Driggers said. “Rather than separate them we wanted to fix the issues together. Those issues were both the result of that Nov. 9 meeting.”

The FCA petitioned the board for a determination on dry needling and whether it was within the chiropractic scope of practice to do so. Facing opposition at the board meeting, the FCA ultimately withdrew the petition.

While laws governing chiropractic medicine don’t allow for dry needling, there is a rule that allows athletic trainers to dry needle under the supervision of a physician. Riggers told the committee members that under statutes chiropractors are considered physicians.

The bill heads to the Senate Appropriations Committee on Health and Human Services, which is chaired by Sen. Gayle Harrell. And while Harrell voted to support the bill this week she is not a fan of scope-of-practice expansions.

This isn’t the first tussle over dry needling and what health care practitioners are authorized to conduct the procedures. After an unsuccessful attempt to add dry needling services through rule, the physical therapists in 2020 successfully convinced the legislature to put it into their practice act.

—Dental therapy —

The Florida Dental Association’s efforts this week to quash legislation establishing dental therapy fell short after members of the House Health Care Appropriations Subcommittee voted 9-5 to advance HB 1173 to its next stop.

The measure is supported by the umbrella organization Floridians for Dental Access, as well as the American Children’s Campaign and the Florida Dental Hygienist Association.

In addition to the FDA, the Florida Society of Oral and Maxillofacial Surgeons oppose the bill.

In 2021, Florida hospitals billed nearly $550 million for emergency department and hospital admissions for preventable dental issues, $170 million was billed to Medicaid and $102 million was for the uninsured.

Those statistics are troubling for FDHA Government Affairs Chair Catherine Cabanzon, who says she’s been passionate about expanding dental care access for 23 years.

“I know how hard it is for people to find care. I know when I look at a person’s face, and they tell me they’re in pain and they have no place to go. It destroys you. If you care anything about human beings, you want to make a change,” she told Florida Politics.

Cabanzon, who served on the Board of Dentistry for nine years including a stint as chair (the only non-dentist to ever do so according to her) likens a dental therapist with a physician assistant.

“It’s funny because my husband goes to a surgeon, an orthopedic surgeon, and one day we went there, and he didn’t have his nurse practitioner, and he was like, ‘I don’t know what to do with myself today.’” she said. “I understand change is challenging for people, but it works in that arena. It should be able to work in dentistry as well.”

FDA Governmental Affairs Liaison Alexandria Abboud told committee members that operationalizing a dental therapy program in Florida wouldn’t be free.

“While there is no specific fiscal tacked onto this bill there you have to remember that, should this legislation pass, schools that wish to house this program will be back next year to ask for funding for these programs,” she said. “Furthermore, there is not a current ADEX exam, the bill for dental therapy directs the Board of Dentistry to create its own exam and to administer it. This will cost money.”

HB 1173 now heads to the Health and Human Services Committee. The Senate counterpart, SB 1254, has been referred to there committees, none of which have heard the measure.

—APD dollars —

The Senate on Wednesday approved a bill that appropriates $38 million in recurring funds to the Agency for Persons with Disabilities (APD) to offer waiver services to individuals who have been on a waitlist — which is now called pre-enrollment — for iBudget services.

SB 1758 is considered part of the overall Live Healthy proposal, which has been championed by Passidomo. The bill was passed on “Florida Developmental Disabilities Awareness Day.”

The bill also directs APD and the Agency for Health Care Administration (AHCA), in consultation with other stakeholders, to jointly develop a comprehensive plan for the administration, finance, and delivery of home and community-based services through a new home and community-based services Medicaid waiver program.

The waiver program would be for clients transitioning into adulthood and designed to prevent future crisis enrollment in the iBudget waiver program. AHCA is authorized to contract with necessary experts to assist in developing the plan.

It must address the purpose, rationale, and expected benefits of the new waiver program; the proposed eligibility criteria for clients and service packages that would be offered; a proposed implementation plan and timeline, including recommendations for the number of clients to be served by the new waiver program at initial implementation; changes over time and any per-client benefit caps and proposals for how clients will transition onto and off the new waiver; and the fiscal impact for the implementation year and projections for the subsequent 5 years, determined on an actuarially sound basis.

It also must include the availability of services that would be offered under the new waiver program; recommendations to increase the availability of such services; and a list of all stakeholders, public and private, who were consulted or contacted during plan development.

AHCA would be required to submit the plan to the Governor, Senate President and House Speaker by Dec. 1.

—RULES —

—The Board of Podiatric Medicine proposes amending Rule 64B18-17.005 regarding continuing education required after initial licensure. More here.

—The Board of Nursing proposes amending Rule 64B9-15.005 regarding the standards applicable to certified nursing assistant training programs. More here.

—The Board of Nursing proposes amending Rule 64B9-16.003 to remove unnecessary provisions and to update the necessary ones. More here.

—LOBBYISTS —

David Allen, GrayRobinson: AvMed

Yvonne Barton: AbbVie

Melissa Braude, Earl Jones Jr., Cody McCloud, The Fiorentino Group: UF Health Jacksonville

Mathew Forrest, Abby Vail, Ballard Partners: Advanced Rx Pharmacy

Allison Liby-Schoonover, Metz Husband & Daughton: University of Florida Foundation

Todd Lewis Pereira, Reyes Consulting: Florida Healthy Alternatives Association

—ETC —

—State health care planners contend the state needs an additional seven hospice programs by July 2025. According to the announcement, there is a need for hospices in 2A, 2B, 3A, 5A, 6A, 9B and 10.

—The Department of Veterans Affairs (VA) updated its health care guidelines to make coverage of in vitro fertilization services available to military families. The new range of covered services includes lab work, infertility assessments, surgery and artificial insemination. Services are still only available to married couples, and the VA won’t cover the involvement of a third party, such as surrogacy or the use of donor eggs or sperm.

—ROSTER —

—Colleen Thielk has been named the Chief Nursing Officer at Good Samaritan Medical Center. She previously served as the Regional Vice President of Operations for Intuitive Health’s Florida and Delaware Markets.

—Dr. Anthony Anfuso, a head and neck surgeon at Precision Healthcare Specialists, was named a 2023 WeCare Top Provider by the United Way of Lee, Hendry, and Glades counties. Anfuso is a fellow of the American College of Surgeons who attended the Medical College of Georgia and completed a residency in otolaryngology at West Virginia University and a fellowship in head and neck surgical oncology and microvascular reconstruction at the University of Miami/Jackson Memorial Hospital. Anfuso treated 18 patients through WeCare, providing services valued at $58,405 in 2023.

—Dr. Martin Rosenthal, an associate professor in the UF College of Medicine’s Department of Surgery, has been named surgical director of the UF Health Shands ORs.

—The Governor appointed Jason Cirolia to the Board of Physical Therapy Practice. Cirolia earned his associate degree from Daytona State College, his bachelor’s degree in health science and rehabilitation services from the University of Florida, his master’s degree in business administration from the University of Massachusetts, and his doctorate in physical therapy from the University of Central Florida.

—The HCA Florida Orange Park Hospital board of directors has three new members. Clay County Sheriff Michelle Cook is among those named to board. She’s joined by attorney David King and Dinesh Madhok, Vice President of Borland Groover. Some of the projects the Florida Orange Park Hospital board is currently addressing include: modernizing and expanding its Imaging assets; doubling the size of the inpatient rehabilitation unit; increasing its cardiovascular care capabilities and the development of a graduate medical education simulation center.

— ICYMI —

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

“Independent hospital districts required to analyze the benefits of going private under House bill” via Christine Jordan Sexton of Florida Politics — Independent hospital districts may have made sense years ago, but a leading House Republican contends they may be antiquated in Florida’s current health care marketplace. Rep. Randy Fine, Chair of the powerful Health & Human Services Committee, filed legislation (HB 1421) that requires the 26 independent hospital districts in the state conduct a market evaluation by the end of the year analyzing the costs and benefits associated with converting their model into a private nonprofit entity.

“Vax statewide grand jury report: ‘Investigation is nowhere near complete’” via Christine Jordan Sexton of Florida Politics — A statewide grand jury set up at the urging of Gov. Ron DeSantis to investigate the companies that manufacture COVID-19 vaccines said in its first-ever report that its “investigation is nowhere near complete” and that it had not gotten cooperation from federal healthcare agencies in its probe. In its 33-page interim report, the grand jury said that while the members have heard from doctors, professors and scientists, “there are still many months and much more testimony and evidence to come before our work will be finished.”

“Bill tightening Florida’s Brazilian butt lift law clears Senate panel” via Christine Jordan Sexton of Florida Politics — The Legislature appears poised to tighten statutes that regulate Brazilian butt lifts. A Senate health care panel approved legislation (SB 1188) which modifies a 2023 law regarding the popular plastic surgery procedures and the physician’s offices where the surgeries are performed. The bill is identical to HB 1561, which cleared a House health care spending panel last week.

“Health care spending agreement? House agrees to Senate’s Live Healthy funding levels” via Christine Jordan Sexton of Florida Politics — The House and Senate have agreed to spend $717 million on a sweeping health care plan meant to increase the state’s workforce by increasing access to graduate medical education and student loans, and to increase reimbursements for an array of health care providers. HB 1549 bill sponsor Rep. Michael Grant told members of the House Health Care Appropriations Subcommittee that the underlying policy contained in the bill will continue to evolve as the proposal moves through the House.

“Senate panel advances THC caps as hedge against pot legalization” via A.G. Gancarski of Florida Politics — A Senate committee advanced some caps on delta-9 THC, the intoxicating cannabinoid prevalent in most commercial marijuana, in the event adult-use cannabis is made legal later this year via citizens’ initiative. The limitations contemplated by the Senate committee measure track to some degree with a parallel bill (HB 1269) in the House, which imposes similar caps on whole flower and the processed product.

—FOR YOUR RADAR —

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

“Florida sues federal health care regulators over ban on removing CHIP recipients” via Arek Sarkissian of POLITICO — DeSantis has filed a lawsuit against federal health regulators after the U.S. Centers for Medicare and Medicaid Services told the state it could no longer remove children from its CHIP-funded program if parents stop paying the required premiums. The CHIP-funded program, Florida’s KidCare, serves more than 119,000 children who are from families that are just above the threshold to qualify for Medicaid. The program offers health insurance plans with premiums that are set by the income level of each family.

“Florida primary care provider Cano Health files for bankruptcy” via Cindy Krisher Goodman of the South Florida Sun Sentinel — Miami’s Cano Health, with more than 1,000 employees and primary care offices across Florida, filed for Chapter 11 bankruptcy protection. The company specializes in senior care. Its Florida offices are heavily concentrated in Miami-Dade, Broward and Palm Beach counties with some locations on the west coast in Tampa and Central Florida in Kissimmee/St. Cloud. Cano’s doctors treat more than 310,000 patients, many of whom are Medicare enrollees covered under value-based plans, according to a company description.

“Orlando Health plans new corporate office tower in SoDo neighborhood” via Laura Kinsler of the Orlando Sentinel — Orlando Health is planning a new 200,000-square-foot corporate office tower near its main campus in Orlando’s SoDo district, according to a report in GrowthSpotter. Members of the company’s development team and their planning firm, GAI Consultants, held a pre-application meeting with city staff to discuss the project, which would rise at 1227 S. Division Ave. Orlando Health purchased the site in 2018 for $1.6 million from AT&T, which previously operated a small office and a warehouse, both built in 1959, on the site. The hospital also bought the adjacent warehouse at 1309 S. Division Ave., increasing the size of the property to 3.68 acres.

—PENCIL IT IN —

Thursday

8 a.m. — The House Health & Human Services Committee meets. Room 17, House Office Building (HOB).

8:30 a.m. — The Senate Rules Committee meets and will consider SB 1112 regarding practitioner health care titles. Room 412, Knott Building.

10:45 a.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.

2 p.m. — The House is in Session.

4 p.m.— The Senate is in Session.

Friday

11:30 a.m. — The House Healthcare Regulation Subcommittee meets. Included on the agenda are 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.

Tuesday

FAU Day at the Capitol

NFIB’s Small Business Day

8 a.m. — The House Justice Appropriations Subcommittee meets. Room 17, HOB.

1:30 p.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.

3 p.m. — The House Health Care Appropriations Subcommittee meets. Room 17, HOB.

Wednesday

Happy Valentine’s Day

11 a.m. — Gator Day at the Capitol

2 p.m. — The Senate is in Session.

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