Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Bad timing? —
They have been called the most lucrative contracts in the country and for more than a week managed care executives lobbyists and even reporters have been waiting for the Ron DeSantis administration to announce the names of the managed health care plans that will ink six-year Medicaid contracts with the state.
By late afternoon Tuesday, the word in Tallahassee health care circles was the announcement would be posted Wednesday morning. Hours later, the intelligence said the announcement would be made Monday, April 8 instead.
The date change is most likely due to state law and how contracts are procured. In short, affected parties are allowed 72 hours to challenge a state decision. The three-day clock is exclusive of weekends and legal holidays.
Had the Agency for Health Care Administration (AHCA) posted the winning plans on Wednesday morning as initially anticipated, it would have given vendors who weren’t chosen or who didn’t get as many contracts as hoped an additional 48 hours to consider their legal strategies. (The same would have happened if the state had announced the winning health plans on Thursday or Friday.)
By pushing the announcement to April 8, affected vendors will have to notify the Agency for Health Care Administration of their intent to challenge the awards by April 11, a year to the day that the Medicaid managed care invitation to negotiate (ITN) was unveiled.
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—What to look for—
The state is divided into nine regions for purposes of Medicaid procurement. Florida Medicaid law specifies the minimum and maximum number of managed care plans the state can contract within each region. Moreover, AHCA has publicly said it intends to reduce the number of contracted plans in each region.
But when the decisions are posted, take a close look at the regions that have fewer than the maximum number of contracted plans. Based on the last procurement, those are the regions where affected vendors could challenge decisions, sources tell Florida Politics.
To cut down on the number of potential challenges AHCA successfully lobbied the Legislature to modify the law to prevent plans from serving Medicaid beneficiaries until all challenges are settled. In instances of challenges, the law also allows the state to contract with other plans in the regions until the administrative challenges are settled so long as the number of contracted plans is less than the maximum allowed under the law.
Florida’s Medicaid law also requires the state to award Medicaid managed care contracts to at least one provider service network in each of the nine regions.
—What about pot? —
As the Supreme Court was releasing its opinion on the recreational marijuana constitutional amendment, word began to spread in the cannabis world that the DeSantis administration may not award new licenses until September.
That’s contrary to State Office of Medical Marijuana Use Director Christopher Kimball’s testimony in December that he hoped the state would move forward with 22 additional licenses, doubling the size of the cannabis industry within the next six months.
Seventy-four applications were submitted about a year ago for 22 additional licenses. The new licenses are required under a 2017 law that requires the state to increase the number of licenses as the number of marijuana users increases.
The latest data from the Office of Medical Marijuana Use shows there are 877,954 qualified patients as of March 29, the latest available data. Whole flower remains the most popular form of marijuana with 111,696.894 ounces of pot dispensed (a little under 7,000 pounds or 3.5 tons) between March 22 and March 28.
In a 5-2 ruling the Florida Supreme Court approved the Adult Personal Use of Marijuana citizen initiative, which could expand the current retail model beyond medical necessity, allowing visitors to the state and residents without qualifying conditions access to the product.
“Our role is narrow — we assess only whether the amendment conforms to the constitutionally mandated single-subject requirement, whether the ballot summary meets the statutory standard for clarity, and whether the amendment is facially invalid under the federal constitution. In light of those limited considerations, we approve the proposed amendment for placement on the ballot,” the Court ruled.
—Up and down —
The Florida Supreme Court made a pair of consequential decisions on abortion rights this week.
Justices on Monday upheld the state’s current 15-week ban on abortion with a 6-1 ruling. Citing a 1989 Florida Supreme Court ruling, plaintiffs argued that the state constitution’s privacy clause prohibited lawmakers from adopting strict abortion regulations.
However, Justice Jamie Grosshans, who authored the opinion, contended that the 1989 ruling was “flawed in several respects,” namely that the text of the privacy clause did not justify the reading the earlier court gave it since it does not directly mention abortion.
As the challenge moved its way through the courts, DeSantis signed a six-week abortion ban and, now that the 15-week ban has been upheld, it will go into effect in 30 days.
But Florida voters will have the opportunity to overrule the court thanks to another ruling that dropped on Monday.
In a close decision, the court ruled that a proposed constitutional amendment constitutional amendment that would protect abortion up to the point of viability, which is generally between 20 and 25 weeks into a term. The measure will appear as Amendment 4 on the ballot.
The issue will now be put to voters. For a constitutional amendment to pass, at least 60% of voters who weigh in on the question in November must vote “yes.”
—AARP score card—
It’s that time of year when advocacy groups start releasing their legislative scorecards on how lawmakers voted on their priority bills.
AARP Florida released its report on Wednesday. It tracked the votes on 65 bills, including ones dealing with health care, such as the “Live Healthy” bills pushed by Senate President Kathleen Passidomo as well as measures dealing with affordable housing and the financial well-being of consumers. AARP said it supported 28 bills that wound up passing.
“AARP Florida approached the 2024 legislative session as a wise friend and fierce defender for older Floridians,” said AARP Florida State Director Jeff Johnson. “AARP emerged from this Session with key wins for older adults, including increasing health care workforce and protecting affordable housing options.”
The organization did not assign legislators an overall grade based on their votes. Instead, its detailed booklet lists how each legislator voted on the key bills the organization was tracking, including measures that failed to pass. The votes included those in committee and on the House and Senate floor. The overall list included bills on the budget, skin cancer screening, and dental services.
AARP also listed votes on bills that it opposed that did not make it through the process, including changes to Florida’s medical malpractice lawsuit laws.
— Nicklaus receives $15M gift —
Nicklaus Children’s Hospital announced a $15 million gift from South Florida philanthropists Helen and Jacob Shaham to further elevate world-class pediatric cancer care and research through the hospital’s cancer and blood disorder institute. In recognition of the gift, the program now proudly bears the name, the Helen & Jacob Shaham Cancer & Blood Disorders Institute.
Nicklaus Children’s Hospital is one of Florida’s four non-profit specialty-licensed children’s hospitals, which also include Johns Hopkins All Children’s Hospital, Nemours Children’s Hospital, and Wolfson Children’s Hospital. Together, Florida’s Specialty Hospitals for Children are collaborating to advance Florida’s position as a leader in pediatric cancer care and ensure Florida families can access world-class cancer treatment for their children without leaving the state.
“This naming gift will be transformational for children with cancer and blood disorders, helping us advance our mission to inspire hope and promote lifelong health by providing the best care to every child,” said Matthew A. Love, president and CEO of Nicklaus Children’s Health System, the parent organization of the hospital.
The Shaham gift is the first to name a Nicklaus Children’s Hospital clinical institute. It is the second transformational gift to Nicklaus Children’s as part of the hospital’s comprehensive campaign to invest in the future of pediatric care, Forward For Generations. Last year, Citadel founder and CEO Ken Griffin donated $25 million to the campaign, naming the Kenneth C. Griffin Surgical Tower which opens this Summer.
— RULES —
— AHCA announced its amending Rule 59G-4.002 to update the provider reimbursement and billing codes. More here.
— AHCA announced an extension for its proposed amendments to Rule 59A-16.107 regarding participant and program data for a comprehensive emergency management plan for adult day care. More here.
— LOBBYISTS —
Jonathan Avichai Weiss: Insightec
David Daniel, Jeff Hartley, Smith Bryan & Myers: Devereux Advanced Behavioral Health
Avery Lopez, Edgar Castro, The Southern Group: Global Kratom Coalition
Bill Rubin, Heather Turnbull, Rubin Turnbull & Associates: Handtevy
— ETC —
— April is National Minority Health Month. The theme for this year’s National Minority Health Month is “Give Your Community a Boost!” The theme focuses on the importance of COVID-19 vaccination, including boosters, as one of the strongest tools to protect communities from COVID-19, which has disproportionately affected communities of color. CDC data show that some racial and ethnic minority groups, particularly Black or African American, Hispanic or Latino, and American Indian or Alaska Native people are at increased risk of getting sick, having more severe illness, and dying from COVID-19.
— AHCA entered orders approving petitions for variances of a rule requiring hospitals to ensure the immediate availability of registered nurses for bedside care of any patient when needed and to have a minimum of one licensed registered nurse on duty at all times on each nursing unit. The petitions were submitted by Orlando Health St. Cloud and Orlando Health South Lake Hospital
— ROSTER —
— Donna Clarke was re-elected Chair of the Lee Health Board of Trustees for 2024. Elected in 2014, Clarke served for nine years. She is a former Florida State Representative and has served as an adjunct professor with the State College of Florida. Clarke has previously owned and operated an environmental consulting firm. She is past President of the Fort Myers Kiwanis Club and has served as Vice Chair of the STARS Advisory Board. David Klein was elected Vice Chair. Meanwhile, David Collins and Dane Allen return as Lee Health Board Treasurer and Secretary, respectively.
— Deborah Gordon has been appointed Executive Vice President and Chief Legal Officer, of Cleveland Clinic, effective June 1. She will succeed David Rowan, who is vacating the post to serve as senior advisor to CEO and President Tom Mihaljevi. Gordon joins Cleveland Clinic from Memorial Hermann Health System in Houston.
—ICYMI—
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Six-week abortion ban set to take effect after Florida Supreme Court ruling” via Christine Jordan Sexton of Florida Politics — Florida will soon put in place a strict ban on abortions six weeks after gestation after the state Supreme Court adopted a major ruling that is expected to reverberate across the entire Southeast. Justices on Monday upheld the state’s current 15-week ban on abortion which means that the six-week ban will now take effect in 30 days. The Florida Legislature made the six-week ban, which was adopted right before Gov. Ron DeSantis launched his bid for President, contingent on the court challenge.
“Florida Supreme Court allows voters to weigh in on recreational marijuana legalization” via AG Gancarski of Florida Politics — Eight years after Florida voters approved medical marijuana, they will have a chance to weigh in on recreational adult use. The Florida Supreme Court gave its approval Monday to the Adult Personal Use of Marijuana citizen initiative, which could expand the current retail model beyond medical necessity, allowing visitors to the state and residents without qualifying conditions access to the product.
“Gov. DeSantis rips Joe Biden for not owning up to ‘transgender visibility’ declaration” via AG Gancarski of Florida Politics — Florida’s Governor is weighing in on President Joe Biden’s official acknowledgment of Easter Sunday as a “Transgender Day of Visibility,” suggesting that his subsequent disavowal of it raises questions about who is running the White House. During a stop in Miami, DeSantis made light of the message confusion between the President and his comms shop.
“Gov. DeSantis signs bill giving state regulatory control over food delivery apps” via AG Gancarski of Florida Politics — Tallahassee will soon have something to say about what happens when you order food from popular delivery apps. DeSantis has signed SB 676, which passed the Senate and House without a “no” vote this Session.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Florida’s 6-week abortion ban will have nationwide impact, critics warn” via Caroline Catherman of the Orlando Sentinel — The law will shutter clinics, limit abortions performed here each year, delay care and send thousands of people across state lines to terminate their pregnancies, they said Tuesday. “[This ban] will affect the entire country,” said Megan Jeyifo from the Chicago Abortion Fund, who added that Florida’s six-week cutoff is “essentially an all-out ban.” Many low-income women can’t afford travel, prompting them to carry pregnancies to term or take abortion pills at home past six weeks, prescribed via telehealth by doctors from other states. “People, rightfully so, are excited about the opportunity to vote to enshrine abortion up to 24 weeks in the state constitution of Florida. But we can’t forget that these are real people’s lives, in the meantime, that are impacted — who won’t be able to access care, who are going to confront many more challenges,” said Stephanie Loraine Piñeiro, executive director of the Florida Access Network.
“Proposal for Sarasota Memorial to adopt Ladapo anti-vaccine guidance stirs controversy” via Earle Kimel of the Sarasota Herald-Tribune — A Sarasota County Public Hospital Board member wants Sarasota Memorial Hospital to incorporate a post on the hospital’s website embracing assertions by Florida Surgeon General Dr. Joseph Ladapo that COVID-19 vaccinations are risky and inappropriate for human use, a stance that federal health officials say is contrary to science and potentially deadly. Board member Victor Rohe raised the idea during the Board’s Jan. 23 meeting, and the topic is now scheduled for consideration when the Board that governs Sarasota County’s public hospital meets May 21. But as word about the possibility of Sarasota Memorial adopting Ladapo’s views spread in recent weeks, several community members preemptively spoke out on the topic at the panel’s March 26 meeting.
“Long-term care gives multiple paths to a fulfilling career” via Shedena Alexander for the Orlando Sentinel — March is Careers in Aging Month — a time devoted to bringing awareness to the many career paths and opportunities available in long-term care. Recent data shows long-term care is still facing historic job losses while other health care sectors, such as hospitals, have generally rebounded back to pre-pandemic levels. I enjoyed my career as a CNA until I suffered an injury in 2020. What I thought was detrimental roadblock in my career ended up being a detour to my true calling in long-term care. My administrator, noticing my passion for providing residents with a high quality of life, suggested I further my education to become certified to serve as Activities Director for the center. She saw something I didn’t see in myself and introduced me to a different, yet still fulfilling, way to work with the residents I love. Now more than ever, we need compassionate people to join the long-term care workforce to care for our seniors both today and into the future. It may surprise you, as it did for me, but it could just be your true calling and a fulfilling lifelong career.
— PENCIL IT IN —
Saturday
Happy birthday to Rep. Alina Garcia.
Sunday
Happy birthday to Rep. Peggy Gossett-Seidman.
Tuesday
Happy birthday to Reps. Robert Brackett and Rep. Tom Keen.
10 a.m. — The FX Executive Steering Committee (ESC) meets. 2727 Mahan Drive, Building 3, Tallahassee in in Conference Rooms A, B, and C. A virtual option will be available via Microsoft Teams Webinar. A copy of the agenda and Microsoft Teams Webinar information will be posted on the FX website.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
