Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— It’s anybody’s guess —
And the suspense continues.
The Agency for Health Care Administration (AHCA) still has not revealed who the agency is selecting to help run Florida’s mammoth Medicaid program. Rumblings through Tallahassee were that the announcement of the winning vendors would be last week, then this Monday. And yet … tick, tick, tick.
The contracts are massive in scope since the managed care companies that are picked will get six-year contracts to administer a health care program that annually costs tens of billions of dollars. The most recent data from AHCA shows that there are 3.45 million Floridians receiving Medicaid through managed care plans.
Medicaid’s overall enrollment is 4.8 million. AHCA’s final decision on which vendors will oversee coverage either statewide or in select regions is one that could draw a lot of scrutiny and even potential bid challenges.
Some of the potential vendors seeking a share of Florida’s Medicaid business have come under fire, including one company that is under investigation into whether one of its subsidiaries unfairly raised insurance premiums.
The timing, however, of when the bids are released has additional implications since affected parties have just 72 hours to protest the decision. But that three-day window does not include weekends or holidays so releasing a decision late in the week gives aggrieved parties additional time to put together a challenge.
Tomorrow marks the one-year anniversary since AHCA initially dropped the Medicaid ITN.
Here is a list of the current plans and the Regions they are authorized to operate in.
Florida Politics has been tracking the procurement and will report on it promptly when decisions are announced.
I welcome your feedback, questions and especially your tips. You can email me at [email protected] or call me at 850-251-2317.
—It’s alive —
After more than three years of work the state this week “took live” its new enterprise data warehouse (EDW), a central component of a Medicaid information technology overhaul called Florida Health Care Connections, or FX.
Members of the FX Executive Steering Committee unanimously agreed Tuesday to take the EDW live after the Centers for Medicare and Medicaid Services certified the technology in March. The certification means that Florida should begin in September receiving support from the federal government for the continuation and maintenance of its IT system.
“Approval from this committee is a huge milestone in our progress on our FX project for better health care for all Floridians and reshaping the landscape for our health care delivery system,” said FX Executive Steering Committee Chair and Deputy Secretary for Health Care Finance & Data Tom Wallace.
The EDW is one of several IT contracts the state procured as it transforms its existing Medicaid IT system from a singular one into a modular interoperable one instead.
The EDW contract included verifying and uploading 500 billion records, according to Deloitte, which controversially inked a $135 million contract with the state for the work in 2020.
Don Hoag, principal at Deloitte, said the journey has included sourcing information that Hoag said was part of the AHCA ecosystem, running data quality checks and consolidating the data into standardized information that can be used not just across agencies but also across other modules.
The new EDW will reduce the time AHCA staff spends gathering and inputting data from different sources and allow staff to instead analyze data that can be culled from the new EDW.
“A lot of times in data analysis you spend 80% of your time trying to just get the data that you need and we want to push that to people being able to spend time making decisions based on data versus collecting data to kind of determine decisions,” Hoag told members of the FX ESC Tuesday.
The new EDW will allow for near real-time data analytics. The modernizations mean that specific data queries can be compiled upward of 400 times faster than current inquiries.
“You can imagine what people can do in that span of time not having to wait for results to return,” Hoag said.
While Hoag did not use the words artificial intelligence he told FX steering committee members that there is “machine learning” in the algorithms that can be used to compile provider score cards and cost modeling.
—FX redesign —
Wallace at times sounded like a cheerleader on Tuesday.
“We’ve had a few challenges along the way here, but we’ve been able to overcome them and get to where we are today,” Wallace told members of the FX Executive Steering Committee, most of whom attended the meeting virtually.
Those obstacles include understaffing and delays — so much so that the FX Executive Steering Committee in December voted to delay for at least 12 months work on one of the FX modules, a $154 million information technology contract and the central part of an overhaul of the FX system. Documents show the delay in implementation is being attributed to a “critical resource constraint” at AHCA, which houses the Medicaid office and has been the lead agency on the overhaul of the management information system that is fundamental to the operations of Florida’s $38 billion Medicaid program.
The Legislature appropriated $5 million to the Department of Management Services to contract with Public Consulting Group to conduct an independent analysis of the FX project.
The first of four reports was completed Jan. 26 according to PCG’s Tyler Cain, who briefly discussed some of the findings and recommendations during a Feb. 20 FX ESC meeting, including a finding that the FX project was understaffed by 47 people.
The 182-page document had not been shared beforehand with the FX ESC members, something that Wallace asked to be done with future reports.
Meanwhile, Cain said a second report would be completed by March 1.
Florida Politics requested a copy of the 182-page report but neither AHCA nor DMS released it by press time.
—Changing FX governance —
Tuesday’s meeting was likely the last for the 15-member FX ESC as it’s currently composed.
That’s because the Legislature this year changed the governance structure, essentially removing anyone who isn’t an AHCA employee.
Representatives from the other state agencies that interact with AHCA and the Medicaid program will instead be part of a stakeholder working group.
Specifically, the legislation requires the stakeholder group to be composed of representatives from the departments of Children and Families, Health, Elder Affairs, and Financial Services. Additionally, it must also include representatives from the Agency for Persons with Disabilities and the Florida Healthy Kids Corporation, and the state’s Chief Information Officer.
The changes are included in HB 5003, a bill accompanying the fiscal year 2024-2025 General Appropriations Act.
Wallace said he wasn’t sure when the next FX ESC meeting would be held.
—Go Gators —
U.S. News & World Report list of America’s best pharmacy colleges ranked the University of Florida College of Pharmacy No. 4 in the nation this week. It’s the second time that the college has secured a top 5 ranking. More than 140 accredited pharmacy colleges were reviewed as part of the analysis.
“Our elevation to No. 4 in the U.S. News rankings reflects the strides made by our college to train the next generation of health care leaders while establishing one of the nation’s best research and patient care programs in academic pharmacy,” said Peter W. Swaan, Ph.D., M.Pharm., dean and professor of the UF College of Pharmacy. “The entire Gator pharmacy community celebrates this achievement, as our new national ranking demonstrates the commitment to excellence shared by our faculty, staff, students, trainees and alumni.”
U.S. News & World Report ranks the best pharmacy colleges every four years and in the 2020 poll was ranked in the top 5, a jump from its No. 9 ranking in 2016.
“It has been impressive to track the trajectory of the UF College of Pharmacy over the past decade when it comes to the national rankings,” said David R. Nelson, M.D., senior vice president for health affairs and president of UF Health, the university’s academic health center. “As a world-class health care system, we need elite programs focused on ensuring every individual receives the exceptional care they deserve, and the UF College of Pharmacy stands at the forefront of pharmacy practice, research and education.”
Cracking the top 5 isn’t coincidental given the College of Pharmacy enjoyed a record-setting year in 2023. The college received $138 million in annual research funding last year. It also matched 154 pharmacists in the American Society of Health-System Pharmacists residency match, the most of any pharmacy college in the nation, according to the university.
The UF College of Pharmacy remains the only program in Florida ranked in the top 50 of the latest U.S. News & World Report rankings.
— Go Noles —
This week leaders at Florida State University and Tallahassee Memorial HealthCare publicly announced they have formalized a long-term partnership with representatives from both institutions signing a memorandum of understanding for the governance of the health center on TMH’s downtown Tallahassee campus as well as on its medical campus in Panama City Beach.
The MOU is intended to create a new not-for-profit corporation to jointly oversee major strategic, research and clinical education decisions for the two organizations. This new structure will help transform the future of health care in the region through scientific progress, programmatic expansion and technological innovation.
The conceptual design of the $125 million academic health center is in its final stages and the site on Tallahassee Memorial Hospital’s campus for the state-of-the-art building has been cleared.
“Since arriving at Florida State University, my leadership team and I have been working diligently to lay the groundwork for FSU Health, a bold initiative that promises to transform the health care ecosystem in North Florida,” said FSU President Richard McCullough.
“The MOU is an important step in solidifying our relationship with TMH and establishing the basic operating and governance structure for our partnership as part of the FSU Health initiative.”
TMH President and CEO Mark O’Bryant said the health care system has been working toward this goal for nearly 15 years.
“This is a monumental step forward in our relationship, and I’m incredibly excited and proud of the work our teams have done,” he said.
But it doesn’t end there. FSU is also contributing to TMH’s partnership with The St. Joe Company to establish FSU Health in Panama City Beach.
This work is critical as North Florida faces significant shortages of health care professionals but also rapid population growth. The development of FSU Health will boost the quality and availability of care in North Florida and beyond.
This campus will open in July 2024 with a medical office building housing physician partner groups, an Urgent Care Center, an ambulatory surgery center, as well as cardiology and orthopedic services. A 100-bed hospital is expected to be completed by the end of 2027. The goal is to eventually have a 600-bed facility with 380,000 square feet of medical office space.
— RULES —
—The Board of Occupational Therapy proposes amending Rule 64B11-5.001 to update the language for continuing education requirements for license renewal of an active license. More here.
—AHCA proposes amending Rule 59A-35.125 regarding the appropriate use of facial coverings for infection control. More here.
—AHCA proposes amending Rule 59A-8.0099 to implement the provisions of HB 391 (LOF 2023-183) to outline training curriculum for home health aides for medically fragile children as well as establish data reporting by home health agencies. More here.
— LOBBYISTS —
David Daniel, Lisa Hurley, Smith Bryan & Myers: Thompson Child & Family Focus
— ETC —
— AHCA approved the expedited Certificate of Need (CON) application from PruittHealth — Ponte Vedra to transfer CON #10721 from PruittHealth — 4-3 to establish a 120-bed community nursing home.
— The Florida Blue Foundation, the philanthropic affiliate of Florida Blue, announced the winners of its Sapphire Awards at a ceremony in Orlando earlier this month.
— ROSTER —
— Claudia Garcia, M.D., has joined Baptist Health Primary Care. Her clinical interests include preventive medicine and nonalcoholic fatty liver disease. Prior to joining Baptist Health, Dr. Garcia was a primary care physician at Chen Senior Medical Center in Miami, Florida She is an associate faculty member at Florida International University Herbert Wertheim College of Medicine, serving as a primary care preceptor for first-year medical students.
— Carolyn Tucker, Candace Hodgkins and Barbara Fradkin, were recipients of Sapphire Awards, bestowed by the Florida Blue Foundation in Orlando earlier this month. Tucker is the Florida Blue Endowed Chair in Health Disparities at the University of Florida in Gainesville. Hodgkins is the President and CEO of Gateway Community Services in Jacksonville, an organization that provides addiction treatment for adults and adolescents in Northeast Florida. Fradkin is a Social Worker, Certified Care Manager, and the Co-chair of the Brevard Parkinson’s Alliance (Melbourne), a nonprofit organization that supports individuals, caregivers and families who are impacted by Parkinson’s disease.
—ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Gov. DeSantis announces expansion of opioid recovery program as he signs new fentanyl laws” via Christine Jordan Sexton of Florida Politics — The DeSantis administration is doubling up its efforts to break the cycle of addiction and reduce the number of overdoses by expanding a medication-assisted treatment program to an additional 17 counties across Florida. DeSantis announced that the Coordinated Opioid Recovery (CORE) Network Model program was being expanded to serve 29 counties total. He made the comments at a news conference where he also signed SB 66 and SB 718.
“UCF’s emergency management program is top in U.S. News and World Report’s rankings” via Gabrielle Russon of Florida Politics — University of Central Florida’s emergency management program is getting national recognition as the No. 1 ranked program in the country, according to U.S. News and World Report’s latest rankings for graduate schools released Tuesday. Rising in the rankings over the past seven years, the university’s Master of Emergency and Crisis Management program teaches students how to deal with human-made and natural disasters. Graduates have gone on to work in Florida, Washington D.C. and around the country.
“DeSantis says Supreme Court ‘controversially’ approved abortion rights amendment” via A.G. Gancarski of Florida Politics — DeSantis is voicing objections even though the same court’s ruling in another case will allow the procedure to be banned after the sixth week of gestation, with the Heartbeat Protection Act taking effect. “The Supreme Court has upheld the pro-life protection that we’ve enacted into law. They also probably more controversially approved language that the Left has been putting on the ballot to try to turn Florida into, like, a California, which would be incredibly radical, overruling parental or parental consent laws having abortion until birth,” DeSantis told Sean Hannity. “That was a 4-to-3 decision. My view is that the language is very confusing.”
“DeSantis signs bill making April ‘Hot Car Death Prevention Month’” via A.G. Gancarski of Florida Politics — SB 554 makes April “Hot Car Death Prevention Month,” intended “to raise awareness of the dangers of leaving children unattended in motor vehicles and how to prevent hot car deaths.” The legislation from Sen. Jennifer Bradley is intended to “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 stresses “motor vehicle safety for children,” including informing people of “criminal penalties associated with leaving a child unattended or unsupervised in a motor vehicle” and ways a “bystander” can “rescue a child who is unattended in a motor vehicle and vulnerable or in imminent danger of suffering harm.”
—FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“A sales tax to pay for cardiac testing? Broward voters may get to decide” via Lisa J. Huriash of the South Florida Sun-Sentinel — Broward voters could get a say on whether they want to pay for eligible residents to have access to free preventive cardiac screening tests. The tests could be funded by a new sales tax, which will be tacked on to things bought in Broward such as clothes, cars and household goods. Now, Broward County Commissioners will decide next week whether to place an item on the Nov. 5, 2024, general election ballot that would create a “Health Care Surtax.” If voters were to agree, a quarter of a percent will be levied for 10 years before being re-evaluated. If approved, the health care tax would add 25 cents of tax to a $100 purchase.
“More funding needed to prosecute pandemic fraud, Justice dept. says” via Madeleine Ngo of The New York Times — More resources are needed to investigate and prosecute individuals who stole billions in pandemic relief funds, the Justice Department said in a report on Tuesday. Federal officials said they have made “significant progress” in going after fraud but conceded that “substantial work remains in the face of numerous challenges.” Agencies responsible for pursuing pandemic fraudsters have been restrained by budget cuts, according to the report. The federal government, which distributed trillions in relief funds after the onset of the pandemic, has charged more than 3,500 defendants for offenses related to pandemic fraud, according to the report. That’s up from about 3,100 defendants who had been charged as of August. More than $1.4 billion in fraudulently obtained funds have been seized or forfeited.
“As Florida restricts treatment for trans adults, one clinic presses on” via Casey Parks of the Washington Post — Any day now, Joey Knoll told himself, he’d grab the bullhorn he kept at the edge of his desk, and he’dtell everyone at Spektrum Health that their yearlong nightmare was over. All of Knoll’s patients had been on edge since the Florida legislature banned nurse practitioners like him from prescribing hormones to transgender people. Florida doesn’t have nearly enough doctors to take up the slack, and so, for many patients, the care simply disappeared when the law took effect last May. A judge had the power to change that.
— PENCIL IT IN —
Thursday
Happy birthday to Rep. Paula A. Stark
Friday
Happy birthday to Rep Jessica Baker.
9 a.m. — The Governor’s Panel on Excellence in Long-Term Care meets telephonically to review the applications received for consideration for the Gold Seal Award. Call (888) 585-9008; participant code: 998518088. Email: [email protected] for a copy of the agenda.
Saturday
Happy birthday to CFO Jimmy Patronis and Reps. John Snyder and Sam Killebrew.
Sunday
Happy birthday to Rep. Ashley V. Gantt.
Tuesday
10 a.m. — The Blood Clot and Pulmonary Embolism Workgroup established by SB 612 meets virtually. More here.
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
