Diagnosis for 6.5.24: 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.

—15 days—

A Florida circuit court judge is giving state economists up to 15 days to come up with a new description for the abortion access amendment that will be on the November ballot.

When voters go to the polls they will see a financial impact statement alongside the citizen initiative that if approved would guarantee access to abortion up to the point of viability. The amendment would supersede Florida’s current six-week abortion ban.

The group that is sponsoring the amendment — Floridians Protecting Freedom — challenged the wording of the impact statement that had been previously drawn up by members of an impact conference.

That statement was worked on and released months prior to the Florida Supreme Court decision that triggered the current six-week ban. It also mentioned a previous 15-week ban that is no longer in effect and how additional litigation was possible. In the end, economists said because of several outcomes they could not determine if the measure would have any impact on state or local revenues.

Judge John C. Cooper, however, concluded on Wednesday that the statement was “inaccurate, ambiguous, misleading, unclear and confusing” and should be redone before it goes on the ballot.

Cooper made it clear he was not directing the impact conference, which is made up of staff from the Legislature and the Governor’s office and the Office of Economic and Demographic Research, exactly what to say but said it needed to reflect the current status of abortion laws in Florida.

Cooper added that he thought it was “speculative” to suggest that an amendment would trigger additional lawsuits or that legislators would pass something in response.

“The parameters should be on what the law is now,” Cooper told lawyers from the bench.

The ruling by Cooper followed a hearing that lasted several hours. Much of the hearing was not centered on the wording of the impact statement but whether or not Cooper had jurisdiction to hear the case and whether local election supervisors should be part of the litigation. Cooper agreed to dismiss the counts of the lawsuit that were directed at election supervisors.

Lawyers representing the Department of State did not argue over the wording of the impact statement but did question whether the case could be considered by Cooper.

The 15-day timeline for economists to redo the financial impact statement will start once a written order is issued. That will likely occur on Monday, Cooper said. It’s not clear if the state will appeal the decision.

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— Unintended consequences —

The Florida Board of Medicine returns to Tallahassee this week for a two-day board meeting.

Day one kicks off Thursday with two BOM Committee meetings and two joint committee meetings between the BOM and the Board of Osteopathic Medicine, a sister board with authority over osteopathic physicians.

Physicians and entities that own medical centers are interested in the new financial responsibility requirements for clinics where gluteal fat grafting procedures (Brazilian butt lifts) are performed.

Yet it doesn’t appear on any of the agendas.

The mandate, contained in HB 1561, went into effect May 13, which is when the Governor signed the bill into law.

Another piece of legislation, SB 1600 by Sen. Jay Collins, also is on the radars of Florida doctors and professional health care licensing associations.

At press time the bill had not been sent to the Governor. It has a July 1 effective date.

The bill creates new statutes spelling out the requirements that health care practitioners, including medical doctors, must meet to qualify for licensure by endorsement. The bill repeals existing law authorizing the BOM to approve licensure applications by endorsement. The bill specifically precludes the BOM from licensing physicians who: have a complaint, an allegation or an investigation pending before a licensing entity in another state or territory; have been convicted of or pled nolo contendere to, regardless of adjudication, any felony or misdemeanor related to the practice of a health care profession; have had their license revoked or suspended by another state; have voluntarily surrendered any license in lieu of having disciplinary action taken against the license; or have been reported to the National Practitioner Data Bank, which includes medical malpractice settlements.

SB 1600 eliminates the section of the statute regarding licensure by endorsement and creates a new universal endorsement statute that applies to medical doctors and a dozen-plus other medical professionals.

Some board members have expressed concerns with the legislation given that the much touted Live Healthy initiative, SB 7016 — which was signed by the Governor last month — makes it easier for internationally trained physicians to get licensed in Florida. The centerpiece of Senate President Kathleen Passidono’s Live Healthy initiative, SB 7016 allows internationally trained physicians to be licensed by endorsement so long as they graduate from World Health Organization-recognized medical schools and complete international medical residencies that are “substantially similar” to those endorsed by the Accreditation Council for Graduate Medical Education.

Internationally trained physicians with medical malpractice settlements or who have a pending complaint allegation or investigation aren’t precluded from the endorsement path.

Some BOM members sounded off about the issue at the board’s last meeting.

“In the totality of the Legislative Session, we are making it easier for foreign medical graduates to practice in the state of Florida, but we are making it impossible for people who are American doctors who had any lawsuit or a DUI 30 years ago or whatever else to have any mechanism to be licensed in the state of Florida,” said Wesley Chapel dermatologist Amy Derick.

Former BOM Chair and Winter Haven physician David Diamond said at the time he thought the BOM “should go on record.”

“Although the intent was the best intentions, the repercussions of this will be detrimental to the people of the state of Florida. The whole purpose of this exercise was to minimize barriers for licensure and it’s having the perverse opposite effect,” he said.

— Is it decided or not? —

The Agency for Health Care Administration (AHCA) has “closed” the Medicaid Dental invitation to negotiate but has not published the names of the bidders it intends to ink six-year contracts with.

The timeline for the ITN shows that AHCA anticipated announcing the winning bidders on April 29.

The ITN was closed on May 17.

Florida Politics reviewed the MyFloridaMarketPlace (MFMP) procurement website, the Florida Administrative Register, published Medicaid notices, and AHCA press releases for announcement of notice of intent to award the dental contracts but could not find a published notice.

Florida Politics earlier this week requested the notice of intent to award the contract but the state did not provide notice by deadline.

AHCA issued three invitations to negotiate Medicaid services, one for dental services; one a pilot project to provide care in a managed care setting to people with intellectual and developmental disabilities; and one for the state’s managed medical assistance and long term care programs.

AHCA closed the statewide Medicaid managed care ITN on April 17, 72 business hours after posting its notice of intent to award. Likewise, AHCA closed the ITN for the pilot program on Feb. 14, 72 business hours after posting its notice of intent to award.

— Hearing scheduled —

Florida’s lawsuit challenging new federal health care rules dealing with gender affirming care is getting its first major hearing later this month.

U.S. District Judge William Jung, the same judge who last week tossed out (without prejudice) Florida’s lawsuit challenging federal health care rules dealing with children’s health insurance, has scheduled a June 21 hearing on the case.

At that hearing, Jung will weigh Florida’s request to temporarily block new rules for federally-funded health care programs such as Medicaid. The rules bar discrimination by sex but include gender identity and sexual orientation in the definition. Attorney General Ashley Moody has asserted the new rules conflict with existing state laws on puberty blockers and surgery dealing with gender transition. Florida, along with the Catholic Medical Association, first filed its lawsuit in early May.

The state is seeking a preliminary injunction while the case moves ahead. In a mid-May court filing, lawyers for the state argued that the Affordable Care Act does not grant authority to the U.S. Department of Health and Human Services to put in place the new rules as the department contends.

“The rules will also impose immediate and irreparable harm on plaintiffs by forcing them to incur irrecoverable costs and by unlawfully pressuring Florida to surrender its sovereign interests,” states the court filing.

HHS officials, who have not yet filed a response to Florida’s lawsuit, defended the rules as a way to prevent discrimination when they were first announced.

HHS Secretary Xavier Becerra called them a “giant step forward for this country toward a more equitable and inclusive health care system, and means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS.”

— Bankruptcy, but no layoffs? — 

Steward Health Care, which operates eight Florida hospitals, filed for bankruptcy last month but its Chief Strategy Officer, Rubén José King-Shaw Jr., told Florida Politics no one will lose their job.

“We have made no plans to lay off anyone,” King-Shaw, a former AHCA Secretary, told Florida Politics. “We have no plans for that.”

The Dallas-based company in May filed for protection in the U.S. Bankruptcy Court for the Southern District of Texas.

King-Shaw was in Tallahassee for two days last month, in part to attend a reunion of AHCA Secretaries held at current secretary Jason Weida’s home.

Steward operates Coral Gables Hospital, Hialeah Hospital, North Shore Medical Center and Palmetto General Hospital in Miami-Dade County; Florida Medical Center in Broward; Melbourne Regional Medical Center and Rockledge Regional Medical Center in Brevard; and Sebastian River Medical Center in Indian River.

Steward acquired the Miami-Dade and Broward hospitals from Tenet Healthcare in 2021.

“Steward does not expect any interruptions in its day-to-day operations, which will continue in the ordinary course throughout the Chapter 11 process,” the company said in a written statement. “Steward’s hospitals, medical centers and physician’s offices are open and continuing to serve patients and the broader community and our commitment to our employees will not change.”

The company also has hospitals in Arizona, Arkansas, Louisiana, Massachusetts, Ohio, Pennsylvania and Texas.

Steward’s troubles in Massachusetts have drawn the ire of top political figures including U.S. Sens. Elizabeth Warren and Edward Markey, who have said the company’s previous private equity owners “sold (Steward) for parts” and “walked away with hundreds of millions of dollars.”

Dr. Ralph de la Torre said in a statement that in seeking bankruptcy protections, Steward will be better positioned to “responsibly transition ownership of its Massachusetts-based hospitals, keep all of its hospitals open to treat patients, and ensure the continued care and service of our patients and our communities.”

The Associated Press contributed to this reporting.

— RULES —

—The Florida Board of Nursing process amending Rule 64B9-15.0025 to clarify responsibilities for education providers and course instructors. More here.

—The Florida Board of Nursing process amending Rule 64B9-4.002 to clarify qualifications, requirements, and standards for nursing specialty certification. More here.

— LOBBYISTS —

—Jeff Johnston, Amanda Stewart, Anita Berry, Johnston & Stewart Government Strategies: PPEC of FL Support, Tender Care Admin

—Michael Corcoran, Jacqueline Corcoran, Matt Blair, Will Rodriguez, Corcoran Partners: Cell Staff

—Darren Patz, DLA Piper US: Advanced Care Partners

—Stephen Shiver, The Advocacy Partners: Imagine Pediatrics

—Mark MacMillin Slobodien: VITAS Healthcare Corporation

— ETC —

—The Florida Health Care Association (FHCA) and the Florida Assisted Living Association (FALA), joined their and national brethren associations, in attending the American Health Care Association and National Center for Assisted Living’s Congressional Briefing. The annual event gives FHCA and FALA association members the ability to discuss with members of Congress the long term care industry’s legislative priorities.

More than 30 FHCA and FALA members met with Florida’s U.S. Senators and their staff to advocate on behalf of the industry. The FHCA and the FALA top priority is blocking a new federal staffing mandate for nursing homes.

The groups claim that the increase in staffing horus is an unfunded mandate on the long term care industry and will adversely impact Florida nursing homes. Nearly 75% of Florida’s nursing centers cannot currently meet requirements. More than 3,800 additional nurses and nurses’ aides would need to be hired to meet the staffing requirements, which will cost facilities an additional $226 million per year.

“In light of the federal staffing mandate, it is more important than ever to meet with our lawmakers and advocate on behalf of our seniors and caregivers,” said Emmett Reed, CEO of FHCA. “Protecting access to care must be a priority, and we look forward to meeting with members of our Congressional delegation and engaging in discussions on how our leaders in Washington can better support our growing elderly population and those who care for them.”

Bijou Ikli, CEO of the Florida Assisted Living Association said: “Assisted living providers continue to struggle with workforce shortages, and a staffing mandate on nursing homes will have a ripple effect across the entire long-term care continuum,” said “Our assisted living facilities are still struggling to return their pre-pandemic workforce levels, and this mandate threatens to reduce the available pool of caregivers that our providers depend on to meet the quality care needs of their residents.”

—The Florida Dental Association Foundation (FDA Foundation) hosted its ninth Florida Mission of Mercy event on May 31-June 1 at the RP Funding Center in Lakeland, which provided donated dental care valued at approximately $2.3 million to more than 1,850 Floridians. Florida Mission of Mercy is a two-day dental clinic sponsored by the FDA Foundation to provide treatment to patients who lack access to dental care. Previous Florida Mission of Mercy events held in Tampa, Jacksonville, Pensacola, Fort Myers, Orlando, Tallahassee and West Palm Beach provided nearly 14,000 patients with donated dental care valued at more than $14.6 million. “We are grateful for the opportunity to provide education, critical dental treatment and preventive care to more than 1,800 community members,” said Dr. Paul Palo, co-chair of the 2024 Florida Mission of Mercy. 

“Florida Mission of Mercy brings together hundreds of dentists, dental professionals, medical professionals, and other volunteers from across the state to help relieve pain and restore smiles while promoting oral health awareness and education,” said Dr. Chris Bulnes, co-chair of the 2024 Florida Mission of Mercy. “We make a significant impact not only on patients but also our communities by providing treatment to those who might otherwise seek temporary care in the emergency room.”

—The Florida Legislature told AHCA to revamp its private duty nursing reimbursement methodology. Lawmakers want reimbursements to reflect differences in acuity and other circumstances affecting the availability of private duty nurses. To that end, AHCA asked Medicaid enrolled home health agencies, independent registered nurses (RNs) and independent licensed practical nurses (LPNs) enrolled in Florida Medicaid to complete a brief survey. Comments were due by May 29. AHCA did not say how many nurses responded to the survey. The agency must submit the proposed reimbursement model to the Governor’s office, the Senate Committee on Appropriations, and the House Appropriations Committee by Aug. 1.

— ROSTER —

—Nemours Children’s Health has hired Katie Flury to serve as its director of external affairs. In this role, she will lead local and state government relations and community engagement efforts across Florida for the pediatric health system. Flury served as government affairs advisor for GrayRobinson’s Orlando office, where she had worked since 2016. “With her extensive experience in government affairs and public policy, Katie will be a true asset to our team,” said Jacob Horner, associate Vice President of state external affairs for Nemours Children’s. “Her unique health care expertise and demonstrated ability to cultivate relationships make her a natural fit for our organization.”  

— 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 signs bill creating grant program for sickle cell disease research, treatment” via Jesse Scheckner of Florida Politics — Treatment centers that help thousands of Floridians with sickle cell disease could soon get a new funding infusion from the state through legislation DeSantis just signed. DeSantis authorized HB 7085, which creates the Sickle Cell Disease Research and Treatment Grant Program within the Florida Department of Health.Under the program, the department’s Office of Minority Health and Health Equity will provide grants to community-based sickle cell disease treatment and research centers. The money is to pay for therapeutic operations, workforce and workforce development costs.

“Gov. DeSantis signs bill imposing restrictions on red light camera programs” via A.G. Gancarski of Florida Politics — Localities that want to impose red light cameras on citizens will need to be more transparent about the process, after DeSantis signed a bill Friday establishing parameters. HB 1363, which passed the Senate and the House without a single no vote earlier this year, puts new stipulations on these controversial devices. Localities are compelled to make annual reports of activity regarding traffic infraction detectors at public meetings. Similarly, local legislative bodies are compelled to approve the contract for these devices during a publicly-noticed meeting.

“Moms for cannabis? Pro-marijuana ad says a legal market is a safer one” via Jacob Ogles of Florida Politics — The 20-second video, entitled “Fact,” features a woman speaking directly to the camera, acting as a Florida mom while offering legalized marijuana as a better path than leaving a black market in place. “Millions of Floridians use marijuana. It’s a fact,” she said. “Most Americans have access to legal marijuana that is regulated and tested for safety but not Florida.”

”Viral Exchange” via Jacob Ogles of Florida Politics — Tense and often insulting exchanges between House Republicans and Anthony Fauci made headlines after a hearing of the House Subcommittee on the Coronavirus Pandemic. However, some attention was generated by a brief back-and-forth between U.S. Rep. Jared Moskowitz and the epidemiology expert. That was mostly for some signature trolling by the Parkland Democrat, who noted that Trump, shortly before leaving office in 2021, gave Fauci a presidential commendation, specifically for his work on Operation Warp Speed in response to the COVID-19 pandemic. Of note, Moskowitz served in Florida as DeSantis’ Director of Emergency Management at the time, once wearing an N95 mask on the cover of INFLUENCE Magazine. DeSantis would go on to rail against mask and vaccine mandates, even suggesting vaccines for COVID-19 pose a health risk despite touring the state distributing vaccines at pop-up clinics in 2021.

“Ruth’s List Florida backs its first transgender candidate with Ashley Brundage endorsement in HD 65” via Janelle Irwin Taylor of Florida Politics — Ruth’s List Florida is endorsing Ashley Brundage in the race for House District 65. The Tampa Democrat, if elected, would be the state’s first transgender woman to hold office in Florida, and it’s the first time Ruth’s List has endorsed a transgender candidate. Ruth’s List is Florida’s only organization dedicated to electing pro-abortion rights Democratic women in the state. Ashley Brundage’s courage to lead and mentor others to draw strength and power from life’s challenges make her uniquely qualified to serve in Florida’s state legislature to work to help Floridians thrive and prosper again,” Ruth’s List Florida CEO Christina Diamond said.

— FOR YOUR RADAR —

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

“Small business, medical freedom and drug policy collide: Will DeSantis veto hemp bill?” via Romy Ellenbogen of the Miami Herald — Thousands of Floridians have called and written DeSantis’ office to urge him to veto a bill that they say would effectively neuter the state’s hemp market and make it harder for consumers to access products they need for their mental and physical health. DeSantis’ office, which has not formally received the bill from the Legislature, declined to comment on the Governor’s stance. But some opponents of the legislation say they’re hopeful their efforts will work. Paige Figi, the executive director of Coalition for Access Now, said while she knows the Governor isn’t a cannabis supporter, she believes he does support CBD health products and the people, including veterans and first responders, who use them.

“Sarasota families reveal the devastating toll of fentanyl in new documentary” via Cathy Carter of Health News Florida — America’s fentanyl crisis isn’t letting up as drug cartels continue to flood communities with the deadly opioid. A new documentary, “The Fentanyl Project,” reveals the impact the synthetic drug has had in Sarasota County. The film, which premiered at the Sarasota Film Festival, focuses on two local families dealing with the unexpected loss of a child and sibling after taking pills they did not know were laced with fentanyl. KT Curran, the film’s director, recently spoke with WUSF’s Cathy Carter.

“Why Florida is America’s least gay-friendly state” via Jeff Weiner and Kathryn Varn of Axios — Florida bans transgender women and girls from participating in sports for female students. Trans people can’t use bathrooms at schools and government buildings that match their gender identity. Books about LGBTQ+ characters have been pulled from school libraries. Minors are barred from receiving gender-affirming health care, despite such treatment having support from every major medical group. And adults face more hurdles to accessing and getting insurance coverage for transition-related medical care. Earlier this year, state agencies barred trans people from changing their driver’s license to match their gender identity. LGBTQ+ advocates are actually more hopeful than they’ve been in recent years. The Florida Legislature, meanwhile, had less of an appetite for culture-war bills than in years past.

— PENCIL IT IN —

Thursday

Happy birthday to Lt. Gov. Jeanette Nunez!

3 p.m — The Florida Department of Health/Florida Trauma System Advisory Council meets. Via Microsoft Teams Meeting ID: 245 694 522 463. Passcode: CaA3tA. Or, call (850)792-137; participant code 912352100.

4 p.m. — The Full Pediatric Cardiac Technical Advisory Panel (PCTAP) meets. Contact Carson Merlo of the Florida Center for Health Information and Transparency at [email protected] or (850)412-3771. Webinar here.

Friday 

Happy birthday to Sen. Jason Brodeur!

Saturday

Happy birthday to Rep. Kevin Chambliss!

Tuesday

Happy birthday to Rep. Jervonte ‘Tae’ Edmonds!

Wednesday

Happy birthday to Rep. Kimberly Daniels!

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