Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Live Healthy —
In the next few days, Gov. Ron DeSantis is expected to sign off on a suite of legislation that is collectively called the “Live Healthy” package. The bills, designed to address workforce shortages and other shortcomings in the state’s health care offerings, were sent to DeSantis on Tuesday. They were the top priority this year for Senate President Kathleen Passidomo.
They were the main health care bills to move across the finish line during the 2024 Session, while other measures faltered in the closing days, including another priority of Passidomo dealing with titles used by healthcare practitioners that flamed out amid another tussle between optometrists and ophthalmologists. Other substantial bills, such as a measure to limit lawsuits against assisted living facilities, also failed to pass.
For Democrats and other public health advocates the “Live Healthy” bills did not address a fundamental problem: Florida — which refuses to expand Medicaid — continues to be one of the states with the highest number of uninsured residents. That’s one reason why Florida leads the nation in Obamacare enrollment.
Passidomo has consistently tried to flip this question — and she did again last week — by insisting that having insurance doesn’t matter if there is no doctor or health care professional available to offer treatment.
Still, the “Live Healthy” package has a substantial price tag of more than $1.2 billion. That is above and beyond the $117.4 billion state budget also passed by legislators. Overall it is a substantial financial commitment to health care programs.
But one looming question for all legislative legacy items: Will the next batch of leaders remain committed to it? In the past decade, legislative leaders have pushed through major pieces of legislation only to watch the projects and funding soon get scuttled by their successors. Passidomo has another two years in office so presumably, she will be able to keep watch — but the situation can quickly change once a legislative leader is no longer in charge.
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— Not fighting old battles —
Just as steadfast as Passidomo is in her refusal to expand Medicaid to childless low-income adults, state Rep. Joel Rudman is determined to do just that.
Rudman quietly met with North Carolina Sen. Kevin Corbin in Tallahassee this Session to discuss the steps Florida could take toward expanding Medicaid and North Carolina’s experience since passing and implementing a Medicaid expansion effective Dec. 1, 2023.
“North Carolina was very hesitant to take Medicaid expansion. You know, three, four or five years ago, there was a lot of hesitation among Republicans who felt like it was a buy-in to a continuation of Obamacare, and that we would be spending money loosely. So over a period of four or five years, I think we’ve come to understand — and folks like myself have been the ones to promote it— that it was gonna be good for our citizens,” Corbin told Florida Politics in February at a meeting in Rudman’s Capitol office.
Corbin said the North Carolina expansion — the state portion of which is funded by revenues from hospitals — is expected to cover 600,000 new people.
“As a Republican and as a conservative, I would agree with a lot of my colleagues that if there was, if there was a private industry solution to this, we should take it,” Corbin said.
“It’s been 14 years. There hasn’t been a private industry solution or a private solution. This worked. So it’s a matter of are we going to address this coverage gap. And in North Carolina have we come to a decision? Yes, yes, we are.“
Corbin was invited to the Capital City by For Florida’s Health, an umbrella coalition that promotes health care access.
“Politically, to be very frank about it. Early on, I think a lot of folks were afraid that if we voted for Medicaid expansion if we supported that, that we would be criticized by our own party, and a lot of us would be subjected to primary elections that folks run against us for that reason. And they would come at us with, ‘Hey, you’re, you’re supporting a Democrat initiative,’ and those kinds of things,” he said.
As of Feb. 13, Corbin said none of the 30 Republicans in that state’s Senate were facing a primary challenge. “People can have a primary for any reason, including (Medicaid expansion). So it just has not been a political issue in North Carolina.”
For his part, Rudman says he wants to build a foundation for a Medicaid expansion in the future.
“If Congress were to ever repeal Medicaid expansion and Obamacare, I’d be the first in line in support of that. But the fact of the matter is, they are never going to. And when you escape that reality, to simply refuse federal dollars for a program that’s never going away is just absurd,” said Rudman.
— Keeping a closer watch —
Florida lawmakers have decided to monitor closely the state’s massive IT overhaul of its Medicaid data system, which has had some fits and starts in recent years.
This year’s recently approved state budget includes more than $92 million for Florida Health Care Connections, or the FX project as it is also known. However, legislators included some strict proviso language in the Agency for Health Care Administration (AHCA) budget regarding the project.
The overall line item has funding for several separate components of the complicated project but legislators stated that the “following maximum amounts are appropriated solely and exclusively for these project components.”
And beyond that, the Legislature is holding 75% of the funding in reserve and will release the funding via budget amendments. Legislators have ordered that state officials give them and the Governor’s office detailed reports about the progress being made on the system including monthly status reports.
In another AHCA budget item, lawmakers explicitly told AHCA officials that money could not be used from that appropriation.
Back in December, the state had to delay work on a key component of the IT overhaul after it was concluded there was a “critical resource constraint” at AHCA in getting the work done. The FX project is designed to replace the state’s current Florida Medicaid Management Information System.
— Long time coming —
Physicians and hospitals that treat workers’ compensation patients could be getting pay raises.
SB 362, which passed the Legislature unanimously, increases the fee limits and maximum reimbursement allowances for physicians and surgical procedures under the workers’ compensation law. Reimbursement for surgical procedures is set at 210% of the Medicare rate and reimbursement for physician visits is at 175% of the Medicare rate.
Health care providers must receive authorization from the insurer before providing treatment, and submit treatment reports to the insurer. Insurers must reimburse an individual physician, hospital, ambulatory surgical center, pain program, or work-hardening program at either the agreed-upon contract price or the maximum reimbursement allowance in the appropriate schedule.
The bill also increases the maximum amount a health care provider can be paid for expert testimony during a deposition on a workers’ compensation claim from $200 to $300 per hour. Providers offering an expert witness unrelated to a case in dispute can be paid $300 daily, up from $200.
It’s not often that the Legislature delves into workers’ compensation legislation because it is a difficult issue that involves a variety of special interests, from the unions to physicians and hospitals, to businesses to insurance companies.
— Negotiated rulemaking —
Unable to draft a mutually acceptable rule on adult and pediatric organ transplantation services, AHCA announced Wednesday its plans to hand-pick a committee whose job is to develop the criteria that hospitals that provide pediatric and adult transplant services must meet.
The size of the panel, who serves on the panel and when it meets is not clear.
The announcement did, though, list the following representatives: a surgeon specializing in heart transplants; a surgeon specializing in kidney transplants; a surgeon specializing in liver transplants; a surgeon specializing in lung transplants; a medical director or program coordinator for a heart transplant program; a medical director or program coordinator for a kidney transplant program; a medical director or program coordinator for a liver transplant program; a medical director or program coordinator for a lung transplant program; a medical director or program coordinator for a hospital that only has a bone marrow program; asocial worker specializing in organ transplant services that is employed by a hospital; an administrator from a hospital currently providing transplant services; an administrator from a hospital not currently providing transplant services in a metropolitan area with a population of greater than 200,000 persons; and administrator from a hospital not currently providing transplant services in a metropolitan area.
At least one of the members representing a kidney program must have experience with pancreas transplantation and at least one individual representing a liver program must have experience with intestine and/or multivisceral transplantation.
At least two of the members must have experience with pediatric heart, kidney, liver, or lung transplantation.
Moreover, the panel will include representatives from AHCA, though the announcement did not say how many staff would be named (presumably they will have the authority to vote?).
AHCA did not say whether it had invited members to serve on the panel, and the announcement did not say when the panel would meet.
Nevertheless, AHCA is asking members of the public whose interests may not be represented to apply to participate.
The application must contain a name, business address, and telephone number; the name of any organization the applicant is representing; a description of the organization or the members of the organization; a description of how the proposed rulemaking proceedings will affect the applicant or the parties that the applicant represents; a statement identifying the reasons why the applicant believes their interests aren’t represented; and a statement that the applicant is willing to negotiate in good faith and can attend the scheduled meeting. Application requests should be emailed within the month to [email protected].
— CON challenges —
AHCA has been put on notice that five of its initial certificate of need (CON) decisions to deny new health care projects are being challenged.
Four of the denials that drew challenges involve Sunrise Community’s 120-bed facility in Miami-Dade County. CON applications were submitted to delicense 16 beds from the southeast Florida facility and to transfer them to four new facilities being built by the same company in Hillsborough County.
CON applications #10747, #10748, #10749 and #10750 were denied.
Martin Coast Center for Rehabilitation and Healthcare also notified the state of its intent to challenge AHCA’s initial decision to deny CON application #10753, which requested approval to add 22 community nursing home beds to its existing 120-bed community nursing home that operates under the same name.
Florida law and CON rules lay out the administrative procedures process for impacted parties.
The state announced it wasn’t going to settle or otherwise reach a final resolution for a month and for parties to know their rights.
“Resolution of these requests for hearings by way of a grant or denial of their certificate of need at issue will determine the substantial interest of persons. Those persons whose substantial interest may be determined by these proceedings including settlements, grants, and denials are advised to govern themselves accordingly and may wish to exercise rights including intervention,” AHCA said in a notice announcing the litigation.
— RULES —
AHCA proposes amending Rule 59G-1.010 regarding Florida Medicaid payments. The policy is available on the Agency for Health Care Administration’s website here and here.
— ETC —
— Friday is Match Day for graduating students at M.D.-granting medical schools across the country. Graduating students will simultaneously open envelopes, learning for the first time where they will spend the next several years completing training in the medical specialty they have chosen to practice. The match information comes from the National Resident Matching Program, the primary system that matches applicants to residency programs with available positions at U.S. teaching hospitals.
AHCA wants hospitals and ambulatory surgical centers to register for an online educational seminar on implementing the Patient Safety Culture Survey (PSCS). The tutorial is March 26 at 2 p.m. These sessions will allow the Agency’s PSCS team to answer questions and provide clarification on the surveys, survey data collection, and submission process during the timeframe leading up to the 2025 PSCS reporting period.
—ROSTER—
— Monique Butler, MD, has been appointed president of Graduate Medical Education at HCA Healthcare. In her new role, Butler is responsible for the enterprise-wide leadership of HCA Healthcare’s Graduate Medical Education (GME) strategy, quality and operations, including the growth and development, program accreditation and clinical performance of more than 300 residency and fellowship programs across 16 states and over 70 teaching hospitals. Butler previously served as the chief medical officer for HCA Healthcare’s North Florida Division for the past three years. Under her leadership, North Florida was consistently recognized for care excellence, quality and physician satisfaction.
— In other HCA news, HCA Florida North Florida Hospital, announced Mark Amox as its new Chief Operating Officer in charge of strategic planning and operations. Amox previously served as President and CEO at Unity Health in Searcy, Arkansas. He also served as Chief Operating Officer at HCA Regional Medical Center in San Jose, Calif., and at Children’s Hospital at Sunrise Hospital and Medical Center in Las Vegas.
— LOBBYISTS —
James Daughton, Douglas Bell, Leslie Dughi, Anna Lewis, Metz Husband & Daughton: bluebird bio
—ICYMI—
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“‘Eyeballs wars’ likely to continue into 2025 Legislative Session” via Christine Jordan Sexton of Florida Politics — It came down to the wire, but the Florida Optometric Association again beat back efforts to ban optometrists from being able to describe themselves as physicians by keeping SB 1112 from being sent to the Governor. The bill pitted the optometrists against the ophthalmologists, a long-standing battle that was infamously coined the “eyeball wars” by former Senate President Don Gaetz. “In the (2024) eyeball wars, neither side blinked,” said Jacksonville lawyer and health care lobbyist Christopher Nuland. Passidomo’s initial bill prevented health care providers from using any titles to advertise themselves that aren’t included in their professional practice act, or in the laws that govern the care and services they are allowed to provide.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Creator of Charlotte’s Web CBD urges DeSantis to veto hemp bill” via Steven Lemongello of the Orlando Sentinel — Paige Figi said she has been trying to talk to DeSantis but hasn’t reached him. The stated purpose of the bill (SB 1698) is to outlaw synthetic chemicals in hemp that can induce euphoria. But Figi, whose late daughter Charlotte took what became known as Charlotte’s Web, a form of non-euphoric CBD, to treat her severe epilepsy, says the measure would also signal the death knell for CBD in the state. Figi said the legislation either was inadvertently too broad or was specifically focused to target hemp and help larger medical marijuana dispensaries. Floridians could vote in November about whether to make recreational marijuana legal because of a citizen’s initiative bankrolled by Trulieve, Florida’s largest medical pot dispensary. “I don’t think anybody has ill will toward the CBD health industry, unless you own a dispensary and want this in your store [instead],” she said.
“Florida is set to stabilize and expand funding for epilepsy services” via Margie Menzel of Health News Florida — After years of uncertainty, epilepsy services are set to see their first stable source of funding from the state. The money, providers say, will help hundreds of thousands of Floridians, their families and their caregivers. “Epilepsy can impact any family and at any moment, without any warning. And this year, epilepsy impacted my family,” says Rep. Jenna Persons-Mulicka, the House sponsor of the budget request. Her stepson has epilepsy. She says it’s been a long road to stabilize his life — and their family’s. “How do you prepare school, in case he has a seizure there? And how do you return him back to living as normal of a life as possible?” she asks. “It’s a hard and difficult journey, not only for the person who has epilepsy but also for the family who’s trying to help that person. And it’s scary …” Epilepsy is a disorder of the brain that causes seizures or periods of unusual behavior and sometimes loss of awareness.
“Don’t stick Floridians with out-of-network ambulance bills” via Mark Postma and Terence Ramotar of the Tampa Bay Times — Ambulance providers are on the front lines of health care, acting as a critical public service. Yet despite the vital role emergency ground transportation plays, more and more health insurance companies are no longer covering or providing adequate reimbursement for EMS providers for these essential lifesaving services. As a result, many Floridians are being forced to pay for their ambulance trips out of pocket. Floridians can help by telling their state lawmakers to fight to make sure they don’t get stuck paying for their next ambulance ride by filling this gap in the system during the next Session. With the bill stalling this year, patients are left at the mercy of their insurance companies — often forced to consider monetary implications during an emergency. Similar bills have passed in Louisiana and Arkansas in recent months, while Texas, California and Colorado have similar statutes.
“Who’s a good boy? Bill allowing virtual vet visits in Florida passes, awaits Governor’s signature” via Fresh Take Florida — Milo, a 3-year-old goldendoodle, was recently diagnosed with Addison’s disease, which means he lacks the steroid production to calm down when stressed. “(He) can die from it if (he’s) not treated. But with treatment (he’s) perfectly fine,” said Varesha Mauney, 56, of Palm Beach Gardens in South Florida. Mauney said Milo’s health care requires daily treatment. “He has to take medication for the rest of his life,” she said. Caring for his condition can be costly and time-consuming — care that may now become less burdensome for Mauney and thousands of others across the state now that the Legislature unanimously passed a bill authorizing virtual veterinary care.
“Measles outbreak at Broward elementary school is officially over, school district says” via Michelle Marchante of the Miami Herald — A measles outbreak at a Broward elementary school is officially over, the school district confirmed Friday. The 21-day infectious period at Manatee Bay Elementary, 19200 Manatee Isles Dr., in Weston, “ended on March 7,” John Sullivan, chief communications and legislative affairs officer for the Broward Public School District, told the Miami Herald in an email Friday. “We appreciate the tremendous support of the school’s administrators, staff and families — as well as the guidance and collaboration from the Florida Department of Health — Broward — throughout this time.” Broward County confirmed nine cases of measles in February, and seven of them were students at the Weston K-5 elementary school. At Manatee Bay, 3% of its student body are not vaccinated. The other two Broward measles cases involved children aged 4 or younger, though the kids did not attend school in the district.
— PENCIL IT IN —
Saturday
Happy birthday to Rep. Chip LaMarca!
Sunday
Happy birthday to Rep. David Smith!
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
