Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Time keeps on ticking ticking, ticking —
As the clock runs down on Florida’s existing managed care contracts, Medicaid officials have been unable to reach an agreement with all seven of the providers that threatened to litigate the state’s decision to award new six-year contracts, and the continued impasse could jeopardize the Jan. 1, 2025, statewide start-up date.
Agency for Health Care Administration officials negotiating the massive Medicaid Invitation to Negotiate have reached agreements with Aetna Better Health, United Healthcare, Molina Healthcare, and Florida Community Care, all of which notified the state of their intent to litigate the April 12 decision.
AHCA officials have been unable to reach agreement with three other plans that threatened to take the state to administrative court: CareSource, Sentara and AmeriHealth Caritas.
Those familiar with the negotiations say AHCA has settled disputes with Aetna, United, and Florida Community Care purportedly offering the plans contracts that allow them to maintain their Medicaid managed care footprints.
AHCA’s agreement with Molina is said to keep the plan operating in heavily populated Miami-Dade County and Monroe County but it no longer would be a contracted Medicaid managed care provider for Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota counties (formerly Medicaid Region 8 now Medicaid Region F).
The inability to date to reach agreement with the other three plans, some worry, puts the agency’s timeline for implementing the new contracts at risk.
A review of the ITN shows that AHCA anticipated rolling out the new contracts on a regional basis between September and October.
The ITN says the agency will establish a roll-out schedule and provide the Medicaid managed care plans the “tools” needed for their mandatory readiness reviews.
The plan-specific readiness reviews are meant to assess the managed care plans’ ability to provide Medicaid covered services to enrollees. As part of the readiness reviews the Medicaid managed care plans are required to, at least 60 days prior to the new roll out, demonstrate that they have adequate networks of providers.
Sept. 1 is 65 days away.
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—Disenrollments for non-payment continue—
Florida’s subsidized children’s health insurance program continues to drop families for failing to pay premiums despite an ongoing legal tug-of-war over the issue.
A top official with Florida Healthy Kids Corp. told state economists on Wednesday that it was continuing with the policy even though the federal government told states receiving federal dollars for their program must keep children continuously enrolled for 12 months.
The administration of Gov. Ron DeSantis has challenged the policy in court but the litigation has been unsuccessful so far. A federal judge appointed by former President Donald Trump threw out the state’s lawsuit, but a notice of appeal was filed this week.
The disenrollment issue came up during a meeting where state economists were trying to draw up new estimates for Florida Kidcare, which includes Healthy Kids coverage as well as other state-backed safety-net programs for children.
Amy Baker, the coordinator for the Office of Economic and Demographic Research, was asking questions about new numbers that show lower than projected enrollment in the KidCare program. This runs counter to initial predictions that children who were bumped off Medicaid would switch over to Florida Kidcare, which offers coverage to low-income families but, unlike Medicaid, requires premium payments.
Jeff Dykes with Florida Healthy Kids said part of the decline was due to people being dropped for failing to pay premiums. Baker then asked about the lawsuit.
Dykes responded that “we have not changed any internal policies.”
Previous enrollment estimates also assumed an influx of new children into the program as a result of HB 121, which expanded income eligibility so families who earn more can qualify for the program.
Florida KidCare is an optional Medicaid expansion created in 1998 for children aged 5-18 living in families earning too much to qualify for traditional Medicaid — which is free — but no more than 200% of the federal poverty level. Families pay monthly premiums and copayments toward the costs of the coverage. The remainder of the costs are subsidized by state and federal Medicaid dollars.
Prior to Jan. 1, 2024, it was optional for states to provide 12 months of continuous eligibility for children enrolled in Medicaid or the Children’s Health Insurance Program.
The 2023 federal budget requires states to provide 12 months of continuous coverage to Medicaid and CHIP-eligible children beginning Jan. 1, 2024. President Joe Biden’s administration announced it would enforce the mandate in an October 2023 FAQ document and that children could not be terminated for failing to pay premiums.
But the DeSantis administration has called this requirement an “unlawful mandate.”
— Florida’s physician workforce —
A blue-ribbon advisory council on the state’s physician workforce meets Thursday to begin assessing the state’s current and future physician workforce needs and recommending strategies to address current and projected needs.
Florida Surgeon General Joseph Ladapo serves on the 19-member panel created in statute to represent a variety of professional health care associations as well as educational institutions. Other members of the Physician Workforce Advisory Council are Ulyee Choe, Anthony Speights, Cuc Mai, Mark Sandhouse, Corey Howard, Michael Patete, Linda Delo, Brett Scotch, Nathan Falk, Peter Cohen, Debra Andree, Jennifer Keehbauch, and Joedrecka Brown Speights, all of whom are physicians.
Danielle Drummond and Gino Santorio, who represent hospitals, are also group members. PWAC member Emily Sikes represents the State University System, while Steven Bennett represents the public. According to the Department of Health, there is one vacancy on the panel.
Informing the group’s point of view, published as the Physicians Workforce Advisory Report, are the results of a mandated physician workforce survey. Physicians are required to complete the survey as part of the initial licensure process as well as re-licensure.
The PWAR summarizes the details of the physician survey including the distribution and composition of Florida’s physician workforce. The Florida Senate relied heavily on the 2023 PWAR when developing Senate President Kathleen Passidomo’s Live Healthy proposal, meant to bolster the state’s health care workforce, including physicians, as the growing Baby Boomer population requires more health care services.
— And who are the members? —
AHCA’s latest attempt to negotiate an agreement on controversial industry rules for organ transplants is two weeks away.
However, according to the state, the names of the 14 people who will serve on the organ transplant negotiated rulemaking committee “are not available at this time.”
Florida law allows agencies to enter into a negotiated rulemaking process “when complex rules are being drafted or strong opposition to the rules is anticipated.” The law requires the agency to appoint a “committee of interested persons.”
Anyone who is not invited to serve on the committee who feels like their interests aren’t represented has 30 days to apply to participate.
The law allows a neutral person to facilitate the negotiation process and specifically allows agencies to “employ other types of dispute resolution alternatives” to negotiate the rules.
It’s not clear if AHCA has hired a mediator.
The rules are necessary after the Florida Legislature agreed to abolish the certificate of need (CON) program for hospitals, a top priority for former House Speaker José Oliva who argued the regulatory program was litigious and contentious, among other things. In lieu of CON, Oliva argued that the state could ensure quality for medically complex programs that once required a CON, such as organ transplants, could be accomplished through rule.
The negotiated rulemaking committee is slated to meet in Tallahassee July 24 and July 25.
The agency first announced plans to appoint a committee in March.
According to the notice, the panel will include surgeons specializing in heart, liver, and lung transplants and a medical director or program coordinator for heart, kidney, liver, and lung transplant programs. Others on the panel include a medical director or program coordinator for a hospital that only has a bone marrow program; a social worker specializing in organ transplant services who 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; an administrator from a hospital not currently providing transplant services in a metropolitan area with a population between 100,000 and 200,000 persons; and an AHCA representative.
Though allowable in law, agencies rarely use the negotiated rulemaking process. AHCA, though, has relied on the process to hammer out rules on neonatal intensive care units and cooling and heating requirements for nursing homes and assisted living facilities.
— More green for the green—
Medical marijuana giant Trulieve has kicked in another $1 million to help sway voters to approve Amendment 3, a measure that would allow recreational marijuana in the state.
Smart & Safe Florida noted the donation in its latest campaign report that covers contributions and spending from June 29 to July 5.
Trulieve, one of the largest medical marijuana vendors in the state, has given nearly $55 million over the past two years to bankroll the effort to get the amendment on the ballot and passed. It has been far and away the biggest backer of the initiative, which has led it to come under fire from opponents such as DeSantis.
Smart & Safe Florida has raised $61.1 million overall since 2022. Its latest campaign report shows that the political committee has close to $12.5 million that it has yet to spend.
Even though the election is still months away, Smart & Safe Florida has already spent money on television and radio ads. Last week, the committee announced its plans to spend over $1 million on radio ads in July featuring John Morgan, aka “Pot Daddy.”
In the ads, the famed trial lawyer who led the push for medical marijuana urged voters to declare their “independence” and back recreational marijuana.
Recreational marijuana needs a “yes” vote from 60% of voters in November in order to pass. A recent poll obtained by Florida Politics found that 64% of likely Florida voters plan to vote for the amendment.
If approved, adults 21 and older would be allowed to possess and purchase marijuana for recreational use.
The biggest opponent to the measure has been DeSantis. He has repeatedly criticized the proposal and has said it will “reduce the quality of life” in Florida and will result in many places across the state smelling like pot. The Republican Party of Florida has also come out in opposition to the initiative.
— RULES —
AHCA proposes amending Rule 4.130 regarding Private Duty Nursing Services. If requested, it will hold a meeting on the proposed rule at 1 p.m. on July 31. More here.
AHCA proposes amending Rule 5 9G-4.261 to incorporate by reference the Florida Medicaid Private Duty Nursing and Family Home Health Aide Services Coverage. More here.
— LOBBYISTS —
David Allen, Leonard Collins, Jessica Love, GrayRobinson: Vapor Technology Association
Andrea Kristin Gheen, PinPoint Results: Overflow Health Alliance
Jason B. Gonzalez, Lawson Huck Gonzalez: Protect Women Florida Action
— ETC —
—The Florida Hospital Association (FHA) has launched what it’s calling an emergency management roundtable series in conjunction with the Florida Division of Emergency Management (FDEM). These roundtable discussions aim to enhance coordination among local hospitals, state and local emergency management professionals and other health care organizations throughout the 2024 Atlantic hurricane season.
“By convening Florida hospitals and emergency management officials in these roundtable discussions, we are fostering a proactive and unified approach to emergency preparedness – before, during and after storms,” said Mary C. Mayhew, president and CEO of FHA. “These sessions will help us better understand and address the unique challenges our hospitals and health care facilities face, so that together we can meet the greatest needs of our communities in times of crisis.”
In a statement, FDEM Executive Director Kevin Guthrie thanked the FHA for “taking the initiative to connect hospitals and emergency management officials statewide and identifying ways to best serve Floridians in times of disaster.”
—The Florida Health Care Association (FHCA) announced it awarded $69,500 in scholarships to 29 long-term care employees.
Four employees are being awarded a $5,000 Bruce Taylor Scholarship to advance their nursing careers. Another 12 long-term care employees will receive a $2,500 scholarship dubbed the Career Climb Scholarship, and 13 nursing home administrators have been given $1500 to support their goals of becoming licensed nursing home administrators. That award is called the Rising Long-Term Care Leader Scholarship.
“Florida’s aging population is rapidly growing, as is the need for dedicated professionals to care for them,” said FHCA CEO Emmett Reed. “We’re proud to support these individuals who have chosen long-term care as their path for a meaningful career. These scholarships are a recognition of their contributions toward enhancing the lives of Florida’s seniors and people with disabilities being cared for in our member centers.“
The 2024 Bruce Taylor, Career Climb and Rising Long Term Care Leader scholarship recipients will be recognized during the Quality Award & Scholarship Ceremony and Celebration, which will be held July 23 during FHCA’s 2024 Annual Conference & Trade Show at the Rosen Shingle Creek in Orlando.
— ROSTER —
Rep. Allison Tant is being recognized as a legislative champion by the Florida Bar’s Elder Law Section due to her advocacy and work on HB 73.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“‘That’s the reality’: Marco Rubio backs Donald Trump plan to nix abortion ban from GOP platform” via Jesse Scheckner of Florida Politics — Marco Rubio says he’s fine with Donald Trump removing a long-standing plan to impose a national abortion ban from the GOP platform. Under the position Trump is proposing, which could become official when the former President is confirmed as the party’s nominee at next week’s Republican National Convention, the party would defer abortion-related decisions to the states.
“Abortion rights initiative’s fiscal impact draws long debate in state panel” via Gabrielle Rouson of Florida Politics —A state panel became gridlocked on the abortion rights initiative’s full fiscal impact — especially on potential litigation costs and whether abortions would ultimately be a Medicaid covered procedure. The Financial Impact Estimating Conference met in a nearly all-day debate to determine the ballot wording that accompanies Amendment 4, which would overturn the state’s six-week abortion ban if approved.
“Medicaid managed care plans popped with more than $33M in liquidated damages last year” via Christine Jordan Sexton of Florida Politics —The Florida agency that oversees Medicaid imposed more than $33 million in sanctions against the health plans responsible for providing coverage in the past fiscal year. Data culled by AHCA shows that as of June 28, the agency took 288 final actions during the fiscal year that started on July 1, 2023. All but one of those final actions resulted in liquidated damages, totaling $33.2 million. Simply Healthcare was the sole Medicaid managed care plan to be sanctioned but the amount was for just $2,500, according to the agency’s compliance dashboard.
“Alma Littles tapped for big job at Florida State University College of Medicine” via Christine Jordan Sexton of Florida Politics — After 20 years at the Florida State University (FSU) College of Medicine, Alma Littles has been tapped to head the college as it expands its footprint across the Florida Panhandle under the moniker FSU Health. “Dr. Littles’ dedication to Florida State University and to the people of Florida has made a profound impact on the health and well-being of thousands of people,” Florida State University Provost Jim Clark said in a statement announcing the hire.
“New requirements for out-of-state licensee applicants worry Board of Medicine members” via Christine Jordan Sexton of Florida Politics — DeSantis approved legislation (SB 1600) giving the Board of Medicine (BOM) 15 days to approve by endorsement licenses for certain out-of-state applicants. However, the legislation also blocks many others from getting licensed through endorsement. Filed by Sen. Jay Collins, SB 1600 helps out-of-state licensees with what Senior Assistant Attorney General and Board legal counsel Donna McNulty described as “squeaky clean” licenses. But, as Board member and Pensacola pediatrician Patrick Hunter lamented at a BOM meeting: “If you’re not squeaky clean it’s a hard stop.”
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Records drop in doctor residency applicants post-Roe v. Wade” via Sam Ogozalek of the Tampa Bay Times — Ritu Sidgal volunteered at a hospice in California in high school, reading to patients and offering bedside comfort. After attending college in Missouri to study biology and global health, she applied to medical schools and eventually moved to Tampa, enrolling at the University of South Florida. She won’t graduate until 2027, but she’s already thinking of specializing in women’s reproductive health care as an obstetrician-gynecologist. “I did very early on fall in love with the idea of healing and medicine and helping others through service,” said Sidgal, 23.
“Most abortions performed last year in Florida done after six weeks, suggesting impact of new ban” via Caroline Catherman of the Orlando Sentinel — About 60% of the abortions performed in Florida last year would be illegal under the state’s new, six-week ban that took effect on May 1. Data from the Florida Agency for Healthcare Administration released June 27 shows that last year, 39.8% of abortions — about 33,000 — were performed before a fetus reached six weeks gestational age and 60% were performed after that six-week mark. Until the new ban took effect, abortions in Florida were allowed up to 15 weeks and before 2022, up to 24 weeks. The six-week ban has already had visible impacts, sending more people out of state and to the internet for abortion-inducing pills, along with shrinking revenue at abortion clinics like The Center of Orlando for Women, which started a GoFundMe to stay afloat following a “drastic” decrease in patients.
“A cyberattack at the Florida Department of Health is causing problems for funeral homes” via Adrian Andrews of WFSU — A recent cyberattack at the Florida Department of Health is causing problems for funeral homes statewide. The Florida Department of Health confirmed a group of ransom thieves hacked the state’s “Vital Statistics System,” which is used to process birth and death certificates. Thomas Griffin Jr. works at Strong & Jones Funeral Home in Tallahassee. He told WFSU on Monday that the attack has kept families from receiving burial services. “We can’t accommodate the families at this time period as far as what they need done to accomplish insurance policies and things of that nature,” explained Griffin. “A lot of stuff you can’t get done without a certified copy of the death certificate.”
“Blue-green algae toxin reported in Lake George; Volusia health department issues warning” via Sheldon Gardner of the Daytona Beach News-Journal — People should be cautious when visiting Lake George or the surrounding area because of blue-green algae toxins. The department issued a health alert after a water sample taken on Wednesday tested positive for the harmful toxin, according to a news release from the department. The toxins were found in the lake’s center, a large body of water partly in northwest Volusia County and partly in Putnam County. “Blue-green algae are a type of bacteria common in Florida’s freshwater environments,” according to the health department. “A bloom occurs when rapid growth of algae leads to an accumulation of individual cells that discolor water and often produce floating mats that emit unpleasant odors. Blue-green algae blooms can also appear as scum, foam, or paint on the surface of the water in various colors.”
— PENCIL IT IN —
Thursday
Noon — The Physician Workforce Advisory Council meets via Microsoft Teams. Or, call (850) 792-1375; participant code: 309705412.
3 p.m. — The Florida Department of Health/Florida Trauma System Advisory Council meets via Microsoft Teams, [email protected]. Video ID: 1153031722. Meeting ID: 211 591 106 271. Passcode: JU6pms. Or, call 1(850)792-1375; participant code: 819499484#.
Monday
Happy birthday to Rep. Michael Grant!
11 a.m. — The Information Clearinghouse on Developmental Disabilities Advisory Council to advise the Department of Health on establishing and maintaining a clearinghouse of information related to developmental disabilities on its website. A copy of the agenda may be obtained by contacting Maggie Dilger at [email protected].
Tuesday
Happy birthday to Rep. LaVon Bracy Davis!
3 p.m. — The Florida Department of Health/Florida Trauma System Advisory Council meets via Microsoft Teams. Meeting ID: 226 179 362 159 Passcode: j8Zxz8. Or, call (850)792-1375; participant code: 564730532#
Wednesday
11 a.m. — The Rare Disease Advisory Council meets via Microsoft Teams. Or, call 850-792-1375; participant code: 526932225#.
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
