Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
– ‘It’s going to take a lot of work’ –
Gov. Ron DeSantis, contending that Florida is a solid Republican state now, wants members of his party to focus their attention on two initiatives on the November ballot.
DeSantis spoke Wednesday to the Florida GOP delegation in Milwaukee for the Republican National Convention.
The Governor’s remarks included jabs at President Joe Biden and comments on his efforts to change the state’s higher education system.
But the bulk of his comments were aimed at the amendments that would guarantee access to abortion and legalize recreational marijuana. DeSantis explained that he was confident that Republican candidates would win so he urged the delegates to instead turn their attention to the amendments – which would need a yes vote from 60% of voters to pass.
“It’s fun being here, it’s fun being focused on national stuff,” DeSantis said. “These amendments here are a little more difficult.”
DeSantis repeated familiar criticisms about the two initiatives, several of which have been challenged by supporters of the measures, that he said were put on the ballot by “the left.” He called the amendment that enshrines abortion rights up to the point of viability as something that would eliminate all “pro-life protections” in Florida law. Florida recently put in place a ban on abortions after six weeks of pregnancy.
“That is wrong, that is something that we have to defeat,” said DeSantis. “We have to win. And once people know what that is I think that we will be able to do it. But it’s going to take a lot of work.”
DeSantis went in depth about why he is opposed to the amendment that would allow for recreational marijuana, asserting that legalization has failed in Colorado. He also sharply criticized Trulieve, without naming the company, for bankrolling the effort to place Amendment 3 on the ballot.
The Republican Party of Florida has already formally voted to oppose the two amendments. But DeSantis urged members of the delegation to “get engaged” in opposition efforts once they returned home from the convention.
“If Republicans are united on these I don’t think there’s any way they can get to 60%, ” DeSantis said.
DeSantis’ comments come at a time when both supporters and opponents are beginning to crank up their efforts on the initiatives. Smart & Safe Florida, the committee promoting Amendment 3, has already spent millions on television and radio ads.
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– Medicaid heating up –
Temperatures are soaring in Tallahassee and the state’s Medicaid managed care negotiations are beginning to heat up, too.
AHCA filed a motion with its clerk Tuesday to summarily dismiss Imagine Care‘s formal written protest and petition for an administrative hearing regarding the Medicaid ITN and AHCA’s April 12 decision to award contracts.
ImagineCare, which is owned by CareSource, argued in its petition that the state “consistently and unfairly dismissed ImagineCare as a ‘newbie’. Repeatedly, the AHCA Negotiation Team made the unfounded assumption that ImagineCare would be unable to implement the services promised in its reply in Florida, even in the face of ImagineCare’s undisputed MMA and LTC experience and data proving otherwise. In fact, the AHCA Negotiation Team often praised ImagineCare’s innovation, representatives’ experience, and networks. Thereafter, in their private strategy meetings, however, the AHCA Negotiation Team dismissed ImagineCare’s proposal guarantees exclusively because the negotiators failed to comprehend how ImagineCare would deliver its contracted services,” attorneys for the company wrote.
Rather than attacking ImagineCare on the substance of its complaint, AHCA is alleging that the requisite protest bond was not issued in ImagineCare’s name, a requirement in the ITN, and instead issued in CareSource’s name.
The tactic keeps the legal wranglings at AHCA, and out of the public eye, instead of the state Division of Administrative Hearings, where it would otherwise be litigated.
ImagineCare is one of three vendors that competed for Medicaid managed care contracts that, sources tell Florida Politics, the Agency for Health Care Administration has not been able to reach an agreement with.
The other two plans are Sentara and AmeriHealth Caritas.
Of those three plans, AmeriHealth Caritas is the only one with an existing footprint in Florida’s lucrative Medicaid managed care market.
The inability to reach agreement with the other three plans, some worry, puts the agency’s timeline for implementing the new contracts at risk.
Agency for Health Care Administration officials negotiating the massive Medicaid Invitation to Negotiate have made offers to settle disputes 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.
The agreements to Aetna, United, and Florida Community Care purportedly would keep the plans operating in their current Medicaid managed care footprints.
AHCA offered Molina an agreement that 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).
AHCA anticipated rolling out the new contracts on a regional basis between September and October. Before that, though, the agency is required to conduct plan-specific readiness reviews. As part of the readiness reviews, the Medicaid managed care plans are required to demonstrate that they have adequate provider networks at least 60 days before the new rollout.
Sept. 1 is 45 days away.
– Defend those choices –
AHCA is being taken to court over its decisions last month to award or deny applications to open new hospice programs.
The agency published a lengthy list of notices to litigate it had received by the July 15 deadline and said “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.“
To that end, AHCA said in the notice that it would not settle or reach a final resolution for a month.
AHCA tentatively denied 21 Certificate of Need (CON) applications for new hospice programs and tentatively approved nine others. Heavily populated Broward and Hillsborough counties drew the most interest, with seven providers wanting to establish new hospice programs in each area.
The decisions are tentative because they can be challenged, and in this case, they are.
– Scratch that –
AHCA has canceled, for now, efforts to negotiate rules for organ transplants.
The negotiated rule-making committee was supposed to meet in Tallahassee on July 24-25 to reach an agreement on rules governing organ transplants.
AHCA published a notice on Wednesday that it was withdrawing its rule development for organ transplant services. The agency did not say why the proposed rule was being withdrawn but said in a notice that it “intends to re-initiate this negotiated rule-making with meeting dates to be announced in the near future.”
The rules were necessary after the Florida Legislature had agreed to abolish the certificate of need (CON) program for hospitals, a top priority for former House Speaker José Oliva, who argued that the regulatory program was litigious and contentious, among other things. Instead of CON, Oliva argued that the state could ensure quality for medically complex programs, such as organ transplants, could be accomplished through a rule.
Florida law allows agencies to enter into a negotiated rule-making 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.”
AHCA initially published a notice in March that it would appoint a 14-member negotiated rule-making committee to help hammer out an agreement on regulating organ transplant services in Florida.
– Bragging rights –
According to the 2024 U.S. News & World Report “Best Hospitals” rankings released this week, Mayo Clinic-Florida in Jacksonville is the top hospital in Florida.
Mayo is nationally ranked in 10 adult specialties and rated “high performing” in 19 procedures and conditions.
Tampa General Hospital ranked No. 2 in the state. Nationally, it ranked in eight adult specialties and rated “high performing” in three adult specialties and 16 procedures and conditions. Tampa General Hospital also includes data from Tampa General Hospital Children’s Medical Center.
UF Health Shands Hospital ranked No. 3 in the state and is nationally ranked in seven adult and four pediatric specialties and rated “high performing” in three adult specialties and 18 procedures and conditions.
Like TGH, UF Health Shands Hospital’s evaluation includes data from its children’s hospital and its psychiatric and cancer hospitals.
AdventHealth Orlando and Sarasota Memorial Hospital ranked No. 4 and No. 5, respectively.
AdventHealth ranked nationally in four adult and one pediatric specialty and was rated “high performing” in seven adult specialties and 15 procedures and conditions. Included in its review is data from AdventHealth Winter Park, AdventHealth for Children, AdventHealth Kissimmee, AdventHealth East Orlando, AdventHealth Celebration, AdventHealth Altamonte Springs and AdventHealth Apopka.
Sarasota Memorial is nationally ranked in one adult specialty and rated “high performing” in six adult specialties and 17 procedures and conditions.
U.S. News surveyed about 4,500 eligible hospitals. Of those, just 160 are ranked in the nation’s top 50 in at least one specialty.
The data analysis includes more than 67 million Medicare beneficiaries and 1.5 billion medical claims over a five-to-seven-year period in 12 medical specialties and 20 unique surgical procedures or treatment of medical conditions.
Specific to children’s hospitals, Johns Hopkins All Children’s Hospital in Saint Petersburg, is the top-ranked facility in the state and is nationally ranked in seven pediatric specialties. Nicklaus Children’s Hospital in Miami earned the No. 2 spot and ranked nationally in five pediatric specialties.
Arnold Palmer Hospital for Children in Orlando is the state’s No. 3 children’s hospital, nationally ranked in four pediatric specialties. UF Health Shands Children’s Hospital in Gainesville is the fourth-best children’s hospital in the state. Nemours Children’s Hospital-Florida in Orlando rounds out the top five.
Meanwhile, Bascom Palmer Eye Institute-University of Miami Hospitals and Clinics, Miami, is the nation’s top ophthalmology location. That ranking is based on an annual survey of physicians. Ranked hospitals had to be cited by an average of at least 5% of the ophthalmology specialists who responded to U.S. News physician surveys in 2022, 2023, and 2024 and named the hospitals as the place they would refer their most critical cases.
– RULES –
The Board of Psychology proposes amending Rule 64B19-3.003 to update the language regarding current and former board members obtaining credit for serving on the probable cause panel. More here.
–LOBBYISTS –
Mark V. Murray: International Institute for Health Care Professionals
–ETC –
–Diagnostic Clinic Medical Group (DCMG) announced it’s closing offices in Clearwater, Winter Haven, Largo and Saint Petersburg. Roughly 135 employees will be laid off beginning Sept. 3 and ending Dec. 31. Job losses run the gamut from physicians to registered nurses to HEDIS managers.
–AHCA announced that new Medicaid provider agreements are in effect. The state will be accepting the previous form until Sept. 15, but thereafter, only the new version of the form will be accepted. More here.
–ROSTER –
– The Governor has appointed Michael Halpern to serve on the Lower Florida Keys Hospital District. Halpern is an attorney at the self-named firm Michael Halpern, P.A., the owner of the Southernmost House and the founder of Michelle’s Foundation. Halpern earned his bachelor’s degree from Binghamton University, a master’s degree in business, and a law degree from Florida State University.
– Heather Havericak was named CEO of Delray Medical Center. Havericak most recently was the CEO of Broward Health Medical Center, the flagship facility in the Broward Health network. Broward Health is the name under which the North Broward Hospital District operates.
–Dr. Alberto Tano has been appointed by the Governor to serve on the Florida International University Board of Trustees. Tano, of Coral Gables, is the co-founder and medical director of KIDZ Medical Services and Emergency Pediatric Services. He is also a clinical Professor of Pediatrics at Florida International University and an affiliate assistant professor at Florida Atlantic University College of Medicine. Tano earned his medical degree from Universidad Centro de Estudios Tecnológicos
–ICYMI –
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“With abortion ballot initiative looming, both sides fighting for ground and money” via Gabrielle Russon of Florida Politics – A group targeting Hispanic voters knocked on 100,000 doors in Osceola County in the hopes of building momentum for an upcoming abortion rights ballot initiative. The canvasses are out for what is expected to be a tight election in the citizen-led effort to protect abortion rights that would likely overturn the state’s six-week abortion ban.
“Ron DeSantis now says weed legalization would let people have ’80 joints’ at a time” via A.G. Gancarski of Florida Politics – Florida’s Governor thinks that if recreational cannabis is made legal in the state, people will being holding a massive amount of weed. ”It gives you a limitless constitutional right to possess and smoke. I think it’s up to like … 40 joints … is that the three ounces would be 40? More than that, 80 joints. Something like that,” Gov. Ron DeSantis said, urging the Republican Party of Florida to fight the ballot initiative during a breakfast meeting at Milwaukee’s Republican National Convention.
“Abortion rights advocates calls out ‘sham of a process’ leading to language warning about Amendment 4 costs” via Gabrielle Russon of Florida Politics – Abortion rights advocates complained of “dirty tricks” after a state panel drafted ballot language to appear next to an abortion rights initiative that critics worry could scare off voters due to warnings about potential high litigation costs. “They’re trying to cause confusion and hide the real issue: Amendment 4 is about ending Florida’s extreme abortion ban, which outlaws abortion before many women even realize they are pregnant,” said Lauren Brenzel, campaign director for Yes on 4.
– FOR YOUR RADAR –
Aside from coverage by Florida Politics, these stories are worth your time.
“Federal trial that could restore Floridians’ Medicaid begins with Jacksonville mom’s testimony” via Charlie McGee of The Tributary – A class-action trial challenging how Florida terminates Medicaid benefits began Thursday with a Jacksonville woman testifying that she lost her health care coverage because of a process that was too vague and confusing. If she and other plaintiffs are successful, the trial could potentially restore Medicaid to hundreds of thousands of Floridians and force a system overhaul at a potential cost of a billion dollars. Only one of the named plaintiffs in the case, 34-year-old Kimber Taylor, took the stand at the federal courthouse in Jacksonville to open the trial on Thursday. The bench trial will continue with more witnesses beginning July 29 and will ultimately be decided by U.S. District Judge Marcia Morales Howard.
“Health Department issues rabies alert in Osceola after case confirmed in cat” via Brian Bell of the Orlando Sentinel – A case of rabies was confirmed in a cat in the Mill Creek Woods area in Osceola County, the Florida Department of Health announced in a news release. DOH-Osceola is monitoring rabies among wild animals in the area. The agency advised residents and visitors that rabies is currently present in the wild animal population. The agency said that people and domestic animals should always avoid physical contact with wild animals – raccoons, bats, foxes, skunks, otters, bobcats, coyotes – which carry a higher risk of human exposure and a need for rabies post-exposure treatment. If a person is exposed to rabies, receiving appropriate treatment after exposure will protect you from the risk of rabies.
“Feds open investigation into health company that owns several Miami-area hospitals” via Michelle Marchante of the Miami Herald – Federal investigators have opened an investigation into Steward Health Care System, which is in the midst of bankruptcy and is trying to sell all 31 of its hospitals, including eight in Florida. The criminal investigation, launched by federal prosecutors in Boston, is zeroing in on possible violations of the Foreign Corrupt Practices Act, which prohibits U.S. citizens and companies from committing bribery and other corruption overseas to obtain or retain business. The law also requires companies to keep accurate records of their finances. “Steward Health Care can confirm it is aware of and cooperating with an investigation by the U.S. Department of Justice,” Steward spokesperson Deborah Chiaravalloti told the Miami Herald in an email Friday. “As a matter of policy, Steward will have no further comment on this investigation as it remains ongoing.” The U.S. Department of Justice declined to comment. The U.S. Attorney’s Office in Massachusetts said, “We do not confirm or deny investigations.”
“DOH: Poop water is polluting Lovers Key, Bonita Beach, and Hickory Island” via Chad Gillis of the Fort Myers News-Press – Three south Lee County beaches that were tested showed poor water quality along the Gulf of Mexico. The Department of Health’s (DOH) Clean Beaches Program website shows that Lovers Key State Park, Hickory Island and Bonita Beach are all polluted with enterococcus bacteria – poop water. No public advisory was issued by DOH in Lee County, but the agency sometimes tests the waters a second time before issuing advisories. James Douglass, a water quality scientist and professor at Florida Gulf Coast University, said it’s tough to pinpoint an exact source of the pollution in situations like this. “That’s about double the level they’re supposed to be at,” Douglass said of recent samples.
–PENCIL IT IN –
Saturday
Happy birthday to Sen. Darryl Rouson!
Sunday
Happy birthday to Sen. Gayle Harrell!
Monday
Happy birthday to Sen. Victor Torres and Reps. Alex Andrade and Jennifer Canady!
Wednesday
9 a.m. – Economic and Demographic Research DR: Self-Insurance Estimating Conference
1:30 p.m. – Economic and Demographic Research EDR: Social Services Estimating Conference FMAP rates
1:45 p.m. – Economic and Demographic Research Social Services Estimating Conference KidCare expenditures
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
