Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Medicaid announcement pushed back —
Multi-billion-dollar Medicaid managed care contracts are not anticipated to be awarded until March 25.
The Agency for Health Care Administration (AHCA) posted an amended timeline for its Medicaid ITN that shows the state anticipates it won’t finish its negotiations with health plans until March 15 and it intends to electronically post the notice of intent to award two weeks later.
The ITN for The Statewide Medicaid Managed Care Program was released in April 2023, the first of three Medicaid ITNs released that year. AHCA also released a Medicaid Prepaid Dental Program ITN and a Medicaid ITN to test pilot managed care for people with intellectual and developmental disabilities.
The initial timeline for the Statewide Medicaid Managed Care Program shows AHCA intended to post its notice of intent to award contracts by Dec. 11, 2023. AHCA, four months later, bumped the anticipated deadline to Feb. 23, 2024.
The latest anticipated delay is not surprising, given that AHCA didn’t begin negotiating with the health plans that submitted qualifying bids until late January.
AHCA announced earlier this month its intent to award a six-year contract to Florida Community Care to pilot the idea in Medicaid Regions D and I. Region D comprises Hardee, Highlands, Hillsborough, Manatee and Polk counties. Medicaid Region I covers Miami-Dade and Monroe counties.
AHCA, for now, has maintained the anticipated March 29 deadline for it to notice its intent to award Medicaid managed care dental contracts.
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—Health care priorities moving—
A trio of bills that together encompass Senate President Kathleen Passidomo’s Live Healthy proposal were slated to be rolled to third reading in the House Wednesday as Diagnosis went to press. Coverage of the health care bills can be found on Florida Politics. SB 7016, which directs $717 million to bolster the health care workforce, much of it spent on Medicaid reimbursement increases, and SB 7018, which sets up a Health Innovation Fund, were on the House floor.
— MMJ and Black farmers —
A priority bill for the Department of Health (DOH) has been amended to include language addressing Black farmers and medical marijuana licenses.
The Senate Appropriations Committee on Health and Human Services amended SB 1582 this week to include language that directs DOH to revisit decisions to award and deny medical marijuana licenses under a 2023 law that was championed by Sens. Darryl Rouson and Tracie Davis.
The amended bill gives Black farmers who applied for licenses under a 2023 law another 90 days to cure any errors or omissions on their medical marijuana applications.
The amended bill also makes clear that an applicant does not need to meet the statutory prerequisite that an applicant be in business for five years prior to being awarded a license.
When Florida first launched its medical marijuana licensing program, none of the first dispensaries were minority-owned, despite a statutory requirement that a license be awarded to Black farmers who were part of a lawsuit known as the Pigford-class farmers.
The state ultimately awarded a medical marijuana license to Black farmer Terry Gwinn. But another 11 applicants for that permit who were denied sued the state for discrimination. The 2023 legislation is aimed at resolving the outstanding licensure issues for the 11 other applicants by requiring DOH to issue licenses to applicants who corrected the deficiencies in their applications. The bill also gave any applicant who had deficiencies 90 days to cure that deficiency.
DOH only issued three new licenses to the applicants following the 2023 law.
“Unfortunately, some applicants were not able to cure all the deficiencies with their application, largely due to no fault of their own,” Rouson told members of the Senate health care spending panel. “We thought that several licenses would be issued … That has not happened.”
While Rouson offered the history of the issue, Davis, whose district includes one of the original Pigford-class farmers who still does not have a medical marijuana license, told the committee that Senate President Kathleen Passidomo has been working on the amendment and that the amendment also had the support of the underlying bill sponsor, Sen. Ana Maria Rodriguez.
Davis said eliminating the statutory requirement for Black farmers to have been in business for five years should go ahead.
“This requirement doesn’t make a lot of sense when you consider that many of these applicants are well over 90 plus years,” she said.
The amended bill also makes clear that if an applicant who was alive as of Feb. 1, 2024, dies before the completion of the cure process, their death may not be used as a reason to deny the application during the cure process or any resulting legal challenges.
Lobbyists say that language could be problematic because it excludes applicants who applied for a MMJ license when the program was first established but died before Feb. 1, 2024.
At press time a similar proposal had not emerged in the House.
—Cancer funding—
The House and Senate appear to be on board with the Governor’s Office on a restructure of how the state spends hundreds of millions of dollars in cancer funding.
The Senate Appropriations Committee on Health and Human Services this week approved SB 7070 and the House Health and Human Services Committee will consider identical legislation (HHS 3) Thursday.
The bills amend current law to make clear that the Casey DeSantis Cancer Research Program’s mission also promotes the provision of high-quality, innovative health care for Florida cancer patients. The bills also codify in statute the existing Cancer Collaborative and authorizes the Cancer Collaborative to advise the department and the Legislature on developing a holistic approach to the state’s efforts to fund cancer research, cancer facilities, and treatments for cancer patients.
The Cancer Collaborative also is directed to make recommendations on proposed legislation, proposed rules, best practices, data collection and reporting, issuance of grant funds, and other proposals for state policy relating to cancer research.
While an early iteration of the proposal floated by the Governor’s office would have authorized State Surgeon General Joseph Ladapo to appoint the members of the Cancer Collaborative, the House and Senate bills give the Senate President and the House Speaker an appointment. The Governor has two appointments. The bills also allows Ladapo to serve as an ex officio member of the Cancer Collaborative.
Diagnosis first reported the changes in the Casey DeSantis Cancer Program last week.
— Sickle cell —
The House and Senate appear to be willing to take a closer look at sickle cell disease again this year.
The Senate moved a proposal (SB 7070) Tuesday and the House appears poised to pick up a similar, but not identical, proposal (PCB HHS 24-04).
A main difference between the bills is the Senate proposal creates the Sickle Cell Disease Research and Treatment Grant Program whereas the House bill does not.
Additionally, the Senate bill requires all medical doctors, osteopathic physicians and nurses to complete a two-hour continuing education course on sickle cell disease care management as part of every second biennial licensure or certification renewal.
Both bills make changes to the SCD and sickle cell trait screening requirements. While current law requires screening providers to notify a newborn’s primary care provider of sickle test status the bills require the screening providers to notify the newborn’s parent instead. The bills also allow parents who don’t want their newborns and infants to be included on the Florida Newborn Screening Program registry to opt out.
According to a staff analysis of SB 7070, DOH identified 137 newborns with SCD and 5,800 with the sickle cell trait after reviewing 2022 provisional data.
While the bills allow an opt-out, they also broaden the registry from newborns and infants to other individuals who have been identified as having SCD or carrying the sickle cell trait.
—Ketamine veteran study—
The University of Florida may get more than $528,000 to do a study on how effective ketamine could be in treating depression and post-traumatic stress disorder in veterans.
The Senate Appropriations Committee on Health and Human Services this week agreed to pay for the study at the urging of Sen. Jay Collins, who is sponsoring a wide-ranging bill dealing with veterans.
Ketamine is an anesthetic that was first used for animals and then humans. But in recent years it has attracted attention as a possible treatment for depression and suicidal thoughts.
Collins said it was important to do an academic study in order to find out how effective ketamine could be.
“It’s the right way to do business,” said Collins, a former Green Beret and Tampa Republican.
Several senators on the Senate HHS appropriations committee applauded Collins for suggesting the study.
“If this proves to be an effective treatment, we should be able to use it,” said Sen. Gayle Harrell, the Chair of the committee.
— RULES —
AHCA proposes amending Rule 59A-36.011 to outline the staff training requirements and competency testing for Assisted Living Facilities providing specialized Alzheimer’s services. More here.
AHCA proposes amending Rule 59G-6.010 to update the definition of “Direct Care Cost Component.” The revision includes personal care attendant (PCA) services in the “Direct Care Cost Component” of the methodology. More here.
— LOBBYISTS —
Ashley Boxer, The Boxer Strategy: Memorial Healthcare System
Jennifer Bean: Advanced Rx Pharmacy
Patsy Eccles, Patsy Eccles & Associates: Children’s Comprehensive Care Center
Ron LaFace, Megan Fay, Kaley Flynn, Scott Ross, Christopher Schoonover, Capital City Consulting: Acentra Health, Burrell College of Osteopathic Medicine, Precision Healthcare
Mary Montague: Rape Abuse & Incest National Network (RAINN)
— ETC —
— Baptist Emergency Room & Urgent Care has opened at Baptist Medical Park — Nine Mile. Combined emergency room and urgent care construction was a $10 million investment. Sixty new jobs will be created. Baptist Emergency Room & Urgent Care — Nine Mile is a partnership Baptist forged with Texas-based Intuitive Health several years ago to bring the first combined ER and urgent care clinic to Navarre.
“Baptist was the first to bring the combined hybrid ER/urgent care model to the area in 2019. Our first location opened at Baptist Medical Park – Navarre, and patients tell us they love the ease and convenience it offers,” said Brett Aldridge, Chief Operating Officer and Executive Vice President of Baptist Health Care.
— Sabrina Nelson-Winters, DNP, CRNA, APRN, is a Tampa based health care provider who has practiced in the field of nurse anesthesiology for more than 16 years and is a member of the 2023-2025 Board of Directors of the Florida Association of Nurse Anesthesiology. Winters shares her thoughts about trailblazer and CRNA Goldie Brangman, the first African American President of the American Association of Nurse Anesthesiology, and a member of the medical team that treated Dr. Martin Luther King Jr. after an attempted assassination in 1958. Read her editorial here.
— AHCA on Feb. 9 received a PACE application from Kinship PACE of South Florida to serve eligible residents of Broward County. The Legislature in 2021, allotted 300 slots to a private organization that has demonstrated the ability to service high-risk, frail elderly residents in either nursing homes or in the community in Florida through its operation of long-term care facilities.
— ROSTER —
— HCA Florida Westside Hospital announced Drew Tyrer as its new Chief Executive Officer. Tyrer joined the hospital board Feb. 5. He previously served as CEO at TriStar Southern Hills Medical Center in Nashville, Tennessee, for the past two years.
— HCA Florida JFK North Hospital named Tessie Bowmaker as Director of the Critical Care Unit. A retired U.S. Army Reserve Captain, Bowmaker led the ICU and intermediate care ward operations at the 325th Combat Support Hospital in Kuwait from September 2011 to September 2012.
— Damian Green, MD, will join Sylvester Comprehensive Cancer Center at the University Miami Miller School of Medicine this spring to lead its transplantation and cellular therapy services. Green will serve as chief of Sylvester’s Division of Transplantation & Cellular Therapy, as well as assistant director of Translational Research, beginning March 1. He joins Sylvester from Fred Hutchinson Cancer Center in Seattle, where he built a distinguished track record in research and clinical practice treating blood cancers.
— Cathleen Ward was appointed to the Health Care District of Palm Beach County by the Palm Beach County Board of County Commissioners. Ward has been a West Palm Beach City Commissioner since March 31, 2022. She is also a partner at Ward Damon in West Palm Beach, focusing on commercial lending, mergers and acquisitions, real estate, contracts, and general corporate law. Her father, Philip H. Ward III previously served on the board, appointed by former Gov. Rick Scott in 2011.
— Jim Robo, a private investor and former chairman and CEO of NextEra Energy and NextEra Energy Partners, was elected to the Mayo Clinic Board of Trustees. “We are pleased to welcome Mr. Robo to the board,” says Gianrico Farrugia, MD, Mayo Clinic President and CEO. “He has an exceptional track record of driving transformation and excellence and will offer valuable strategic insights as we continue our journey to transform healthcare for the benefit of patients globally.”
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Senate gears up for ‘hot car death prevention’ bill” via A.G. Gancarski of Florida Politics — SB 554 would make April “Hot Car Prevention Month,” intended “to raise awareness of the dangers of leaving children unattended in motor vehicles and how to prevent hot car deaths from occurring.” The legislation from Sen. Jennifer Bradley would “encourage” the Department of Children and Families, the Department of Health, local governments and other agencies “to sponsor events that promote public awareness and education on the dangers of leaving children unattended in motor vehicles and how to prevent hot car deaths.” The bill is called “Ariya’s Law,” named after 10-month-old Ariya Paige, a Baker County baby who was left in a vehicle by a babysitter and died from the July heat.
“Senate approves harassment-free zone around first responders” via Jesse Scheckner of Florida Politics — A bill enabling Florida police, firefighters and paramedics to establish a harassment-free zone around themselves in the field is heading to the House after clearing the Legislature’s upper chamber with unanimous support. Senators voted 39-0 for the measure (SB 184), which would make it illegal for a person to approach or remain within 14 feet of a first responder performing their official duty after receiving a warning to back away. The bill specifies that the restriction applies only to people who intend to threaten, harass or interfere with a first responder’s work. Several Democratic lawmakers raised concerns about that standard. Violators would face a first-degree misdemeanor charge, punishable by up to a year in prison and $1,000 in fines.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Patients see first savings from Biden’s drug price push, as pharma lines up its lawyers” via the Tribune News Service — Last year alone, David Mitchell paid $16,525 for 12 little bottles of Pomalyst, one of the pricy medications that treat his multiple myeloma, a blood cancer he was diagnosed with in 2010. The drugs have kept his cancer at bay. But their rapidly increasing costs so infuriated Mitchell that he was inspired to create an advocacy movement. Patients for Affordable Drugs, which he founded in 2016, was instrumental in getting drug price reforms into the 2022 Inflation Reduction Act. Those changes are kicking in now, and Mitchell is an early beneficiary. In January, he plunked down $3,308 for a Pomalyst refill “and that’s it,” he said. Under the law, he has no further responsibility for his drug costs this year — a savings of more than $13,000. The law caps out-of-pocket spending on brand-name drugs for Medicare beneficiaries at about $3,500 in 2024. The patient cap for all drugs drops to $2,000 next year.
“Lee Health leaders receive analysis of becoming private hospital system” via Liz Freeman of the Naples Daily News — Consultants for Lee Health are recommending the public hospital system continue to explore converting to a private nonprofit entity. The Chicago-based consultants Kaufman Hall hired last Fall included the recommendation in a detailed report that was presented to the publicly elected Lee Health Board of Directors during a three-hour workshop. It assesses the merits and drawbacks of the change. There are many factors that led Lee Health to consider the change, including a 2019 law change that made it easier for competitors to enter the market. While Board members peppered the consultants with questions, the members were asked to submit questions in writing so answers could be provided in writing.
“Florida’s immigration crackdown is scaring patients away from seeking care” via Arek Sarkissian of POLITICO — One of DeSantis’ most controversial immigration moves has led to women shunning mammograms and prenatal care out of fear that they’ll be forced to reveal their immigration status. At issue is a new Florida law requiring hospitals that receive Medicaid dollars to ask patients about their immigration status. Undocumented migrants in Florida are now steering clear of hospitals and clinics, worried that they’ll be arrested or deported, according to 10 immigration advocates, lawmakers and health care officials.
“Florida health officials investigating measles outbreak at Broward school” via Grethel Aguila of the Miami Herald — The Department of Health confirmed that the agency is investigating a measles outbreak at a Broward elementary school. There are “multiple cases” of measles reported at the school, the health department in Broward said in a news release. Broward County Public Schools verified there are at least four cases of measles at Manatee Bay Elementary School. The district didn’t say whether those infected were students, teachers, or other staff at the K-5 school located at 19200 Manatee Isles Drive in Weston. The Sun-Sentinel reported the school’s first case was a third grader with no history of travel.
“Sarah Lodge announces re-election run” via Chloe Nelson of the Venice Gondolier — Lodge announced her re-election campaign for Sarasota Memorial Hospital Board Central District Seat 1. Elected in 2020, the community advocate was named Chair of the nine-member Board last month. “It is a privilege to live in a region with such an incredible and dedicated health care system,” said Lodge, whose three children were born at Sarasota Memorial Hospital. “Our public hospital is not only our largest employer but continues to grow by leaps and bounds to address our community’s needs.” Lodge received her health science degree at the University of Florida in 2003 before moving to Sarasota County, where she continues to work in strategic wealth management and financial advising.
— PENCIL IT IN —
Thursday
8 a.m. — The House Health & Human Services Committee meets. Room 17, House Office Building.
9 a.m. — The Senate is in session. Senate chambers.
Noon — The Senate Appropriations Committee meets. Room 110, Senate Office Building.
Noon — The Senate Fiscal Policy Committee meets. Room 412, Knott Building.
2 p.m. — The House is in session. House chambers.
Monday
Happy birthday to Rep. David Silvers!
Tuesday
10 a.m. — The House is in session. House chambers.
Wednesday
10 a.m. — The House is in session. House chambers.
10 a.m. — The Senate is in session. Senate chambers.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
