Wednesday, February 28, 2024

Diagnosis for 2.27.24: Checking the pulse of Florida health care news and policy

Christine Jordan Sexton

February 28

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

— Budget bumped —

State legislators are racing to wrap up work on a new health care budget for the coming year, but a final resolution isn't coming together as easily as expected.

Legislators last week had already agreed to infuse more than $717 million to train a future health care workforce and to increase the Medicaid rates paid to providers to prepare the state's health care delivery system for aging Baby Boomers and others living in Florida.

Thease funding agreements did not, however, make it any easier for House and Senate health care budget conferees to negotiate a health care spending blueprint for the 2024-25 fiscal year.

House Health Care Appropriations Subcommittee Chair Rep. Sam Garrison announced Wednesday morning that the House had decided to bump the health and human services section of the budget to Rep. Tom Leek and Sen. Doug Broxson, the House and Senate budget chiefs, to hammer out.

*The 2024-25 health care budget is now in the budget chiefs' hands. Image via Colin Hackley.*

Garrison said the House decided after receiving the Senate's first budget offer Tuesday night. That pass by the Senate didn't include any offers on member projects, nor did it respond to a previous House offer on member projects that was made Monday night.

"I had a good good friend of mine in the upper chamber from years ago who told me that, 'You know, everything's related to everything.' So when you're negotiating a budget, to not have projects makes it challenging for us to do some of the other things that we're trying to do to move forward," Garrison said. "So with that understanding, I'm afraid, unfortunately, we are at a bump in the road, and we have a situation where we are going to have to bump the remainder of the budget now."

Before bumping the HHS budget, though, the chambers were able to reach an accord on several spending issues, including earmarking $80 million for cancer innovation grants, $10 million for rural hospitals, and $10 million for sickle cell research and treatment.

Prior to adjourning the meeting, Garrison told members the projects in both the House and Senate HHS budgets were still in play.

"The good news is they are still in play. The bad news is they are still in play as there have been no project offers from the Senate so the big chairs will have to deal with that."

In addition to bumping the monetary budget issues, Garrison said the health conferees were bumping the proviso, implementing, back of the bill, and conforming language.

"I will say we are going to have a budget. It's going to be a good budget that works for the House and the Senate and all our members and, more specifically, for the constituents that we all serve. Health care is critically important to our state and to all Floridians. So we will have a budget that will be done on time."

Garrison said both he and Harrell would continue to be engaged in the budget negotiations.

I welcome your feedback, questions and especially your tips. You can email me at SextonHealthNewsletter@gmail.com or call me at 850-251-2317.

— The projects that lined up —

Garrison said the decision to bump the HHS budget was made because the Senate's initial budget offer didn't address member projects. The House's initial offer was to spend nearly $187.5 million in general revenue and another $28.4 million in trust funds on member projects.

*The budget was bumped over member projects, but Gayle Harrell and Sam Garrison did align on some items. Image via Colin Hackley.*

As passed, the Senate budget spent nearly $138.8 million in GR and another $11.1 million in trust funds on member projects.

Some of projects that lined up after the House's first budget offer include:

—$500,000 for the ARC of the Treasure Coast.

—$200,000 for the Independence Landing Workforce Training Facility for Persons with Disabilities.

—$350,000 for A Door of Hope — Recruitment and Services for Foster Families.

—$600,000 for Centerstone Trauma Recovery Center.

—$250,000 for Clay Behavioral Health Center.

— $1 million for the Crossroads Hope Academy — Facilities Serving Foster Youth 2.

—$250,000 for the EJS Project Teen Center 2.

—$400,000 for the Florida Association of Recovery Residences — Data Analysis Enhancements.

—$756,822 for Gateway Community Services — Project Save Lives.

—$350,000 for the Gracepoint Wellness Center — Hillsborough County Baker Act Beds.

—$400,000 for Marion Senior Services — Co-Responder Program.

—$562,000 for Miami-Dade County Homeless Trust — Housing First for Homeless Persons.

—$350,000 for New Life Dream Center — Substance Abuse Treatment Program.

—$325,000 for Okaloosa-Walton Mental Health and Substance Abuse Pre-Trial Diversion Program.

— $475,000 for One More Child Single Moms.

—$350,000 for the Personal Enrichment through Mental Health Services (PEMS) — Crisis Stabilization Units Bed.

—$525,000 for the Recovery Connections of Central Florida — Mobile Recovery Support Services for Substance Use Disorders.

—$1 million for the South Broward Hospital District — Medication Assisted Treatment.

—$350,000 for Tampa Bay Thrives — Youth Mental Wellness Support.

—$300,000 or The Lord's Place — Mental Health Care for People Experiencing Homelessness.

—$500,000 for the USF Opioid Incident Response Simulation Modeling & Healthcare Professionals Training Program.

—$525,000 for Recovery Connections of Central Florida -Mobile Recovery Support Services for Substance Use Disorders.

—$200,000 for Green Cove Springs Senior Center Emergency Generator.

—$350,000 for Home Delivered Meals for Elders in Northeast Florida.

—$750,000 for Hope for Grateful Hearts.

—$300,000 for Miramar Southcentral/Southeast Focal Point Senior Center.

—$755,890 for Senior Friendship Centers.

—$1.5 million for Auditory Oral Intervention for Children with Hearing Loss Program.

—$781,614 for Collier County NCH Flood Barriers.

—$590,000 for FASD Statewide Clinics.

—$350,000 for the Good Health Clinic Health Clinic Building Project.

—$400,000 for Five Star Veterans Center Expansion: Phase 1.

—$374,000 for Five Star Veterans Center Homeless Housing and Re-integration Project.

—$1.5 million for the state of Florida's Missions Suicide Prevention.

The Senate, though, never made a counter on the offer, meaning even though the projects may have lined up they weren't agreed to before the budget was bumped to the House and Senate Appropriations chairs to be settled.

—The bigger projects —

There are some large member projects in the HHS budget and, not surprisingly, large discrepancies in their funding levels.

For instance, the House budget includes a $7.5 million appropriation for UF Health Jacksonville. The appropriation is absent from the Senate budget, though.

And that's not the only example where the House has directed at least $1 million toward a member project that received little to no funding in the Senate budget.

*There were large gaps in several projects in the health care silo. Stock image via Adobe.*

Other examples:

—Easterseals Better Together: $7 million in the House, $500,000 in the Senate.

—Easterseals Better Together-Volusia: $3 million in the House, $0 in the Senate.

—Gracepoint Behavioral Health Hospital: $3 million in the House, $0 in the Senate.

—Apalachee Center, Lifestreaillion, and Gracepoint for the operation of forensic residential step-down: $2.7 million in the House, $0 in the Senate.

—Second Harvest Food Bank of Central Florida — Food Cost Mitigation Project: $1.1 million in the House, $0 in the Senate.

—Meals on Wheels — Pinellas County: $2 million in the House, $0 in the Senate.

—Bitner Plante ALS Initiative: $2.5 million in the House, $0 in the Senate.

—Brooks Rehabilitation Feeding and Swallowing Clinic: $1.6 million in the House, $0 in the Senate.

—Big Bend Hospice, Inc. — Mobile Medical Unit for Rural Healthcare Access: $1 million House, $0 in the Senate.

Stay tuned …

— Here comes the 'reign again? —

Legislation that increases the amount of money the government can be required to pay in civil lawsuits (SB 472) is moving through the Florida Senate.

And, despite a companion measure (HB 569) getting slowed down in the House, the proposal could make it across the 2024 legislative Session finish line

The Senate Rules Committee on Monday unanimously approved the bill, clearing it for a floor vote. Filed by Sen. Jason Brodeur, SB 472 initially would have doubled the caps — currently set at $200,000 for a single person and $300,000 per incident to $400,000 and $600,000, respectively.

The committee, however, tagged an amendment onto the bill that set the caps at $300,000 per person and $500,000 per incident, a change Brodeur said was designed to remove the "friction" surrounding the measure and get it passed.

"This is a bill in which I don't think anybody's happy, I don't even like the bill," Brodeur said. "But I think it needs to be done."

*At this point, not even sponsor Jason Brodeur likes the sovereign immunity bill.*

The House counterpart, HB 569 filed by Rep. Fiona Farland, has cleared the House Civil Justice Subcommittee and the House Appropriations Committee.

While the bill appeared on the House Judiciary Committee's Feb. 14 agenda, a vote on it was deferred after Judiciary Committee Chair Tommy Gregory tried to use it as a vehicle to move his bill on third-party litigation financing (HB 1179), which is supported by the Florida Justice Reforillion Institute and the Florida Chamber, among others.

Gregory twice could not get the support he needed to move the bill through the House Justice Appropriations Subcommittee. Dissuaded but not defeated, Gregory directed the House Judiciary Committee staff to draft a proposed committee bill or the judicial panel to consider the rolled-together bill.

If SB 472 passes the Senate and is sent to the House, the chamber could agree to waive its rules and remove HB 569 from the Judiciary Committee and bring it to the floor for a vote.

—Bills are dying —

As lawmakers edge closer to the end of Session on March 8, several contentious health care bills are beginning to fall to the wayside or face uphill battles with time running out.

Sen. Erin Grall this week announced this week that she was dropping her push to allow someone to sue for the death of an unborn child, a measure that had been viewed by abortion rights supporters as a way to sue doctors.

The legislation (SB 476) came under increased scrutiny after the Alabama Supreme Court said that frozen embryos could be considered children — a move that led some health care providers in that state to suspend fertility treatments.

*Erin Grall conceded that the 'personhood' bill will not make it through the Legislature this Session.*

Additionally, Rep. Randy Fine's bill (HB 1421) that would require hospital districts to study whether they should sell off their assets to a private company or transition to a nonprofit organization is scheduled to be heard on the House floor for the first time on Friday.

The Senate version, however, has failed to move through a single committee, a sign that the legislation is not under serious consideration in that chamber and would require a whole series of procedural moves to even come up.

Fine's bill (HB 1431) on international drug pricing also appears to have died.

— 3 Questions —

For over 45 years, the nonprofit Florida Network of Youth and Family Services (Florida Network) has provided prevention and early intervention services to vulnerable youth and families in all 67 counties, with the goal of preventing crises from becoming catastrophes.

Florida Network President and CEO Stacy Gromatski spoke with Diagnosis about Florida Network's Children and Families in Need of Services (CINS/FINS) programs — funded by the Florida Department of Juvenile Justice (DJJ) — as well as a new report highlighting the return on investment and cost savings these services provide the state.

*Stacy Gromatski. Image via Florida Network.*

Q: Can you tell us more about Florida Network's CINS/FINS programs? Why are these services important?

Gromatski: CINS/FINS programs are codified in Ch. 984, F.S. and funded by DJJ, allowing Florida Network and our 27 member agencies across the state to screen, assess, and offer free services to runaway, habitually truant, ungovernable, or homeless youth, ages 6-17, and their families. From counseling to residential sheltering and so much more, we help them improve their behaviors, resolve conflicts, and start communicating again, which ultimately lays the groundwork for future success.

Q: What is the fiscal impact of Florida Network's CINS/FINS programs? Can you share a few key takeaways from the new report?

Gromatski: We see how our work transforms young lives and strengthens families every day, but this new report helps prove that the state's investment in Florida Network's CINS/FINS programs is worth every penny. Research shows that Florida saves hundreds of millions of dollars as a result — $410 million from January 2022 through June 2023 — and there's a $9.19 return on investment for every $1 invested by the state. It's pretty remarkable.

Q: With Sine Die quickly approaching, what level of funding is the Florida Network hoping to receive this year?

Gov. DeSantis' and the Senate's proposed budgets fully funded Florida Network's CINS/FINS programs at $6.2 million in recurring funds from the start, and this week, the House brought its offer up to match that level of funding. This is great news that will allow us to maintain critical, often lifesaving crisis services across the state.

—RULES —

The Department of Health proposes amending Rule 64J-2.018 to add autonomous advanced practice registered nurses and physician assistants as health care providers that are authorized to sign "Do Not Resuscitate Orders." More here.

— LOBBYISTS —

Franz Matthew Schulze: American Society for Clinical Pathology

Natalie Fausel, Brett Cyphers, Anfield Consulting: Florida Smoke Free Association

Robert Patrick: Advanced Medical Technology Association (AdvaMed)

Robert Schenck, The Legis Group: ARC Broward

Carlos Trujillo, James Card, Gangul Gabadage, Continental Strategy: South Broward Hospital District

—ETC —

—AHCA issued a Final Order Feb. 21 denying in part and granting in part the limited conditional Petition for Variance of paragraph 59C-1.040(3)(c) which requires separate regulation of adult and child psychiatric units. The request to use a 12-bed adult psychiatric unit as a swing-bed unit is denied. However, the request to apply for a licensure change of bed designation from adult to child and from child to adult without repeated building code review is granted.

—AHCA received and accepted 42 letters of intent for the March 27, 2024, application filing date for the Hospice batching cycle. If requested within 14 days after notice that an application has been filed, a public hearing may be held at the local level within 21 days after April 24. AHCA will publish tentative hearing dates on April 3. More here.

—ROSTER —

—Stacey Comerford is the new executive director of the American Heart Association Palm Beach County and Treasure Coast. In her new role, Comerford will oversee all fundraising and external-facing operations of the organization.

*Jodi LoDolce is heading to HCA Florida JFK Hospital.*

—Jodi LoDolce was named the Chief Nursing Officer of HCA Florida JFK Hospital, which is part of HCA Florida Healthcare. She previously served as the Chief Nursing Officer for HCA Florida St. Lucie Hospital, a position she held for 18 months.

—Madonna Stotsenburg, the director of Trauma and Emergency Services at St. Mary's Medical Center, was appointed by DeSantis to serve on the Florida Trauma System Advisory Council.

—ICYMI —

In case you missed them here is a recap of other critical health care policy stories covered in Florida Politics this past week.

"Kathleen Passidomo says legislation barring trans identity from licenses won't be heard in Senate" via Jacob Ogles of Florida Politics — Senate President Kathleen Passidomo says controversial legislation limiting transgender individuals from changing their gender on their driver's licenses won't be heard in her chamber. The measure also would have required insurance companies covering gender reassignment surgery to cover de-transitioning as well.

"Bill banning all but 23 Big Tobacco-owned vape products heads to Senate floor" via Jesse Scheckner of Florida Politics — A bill that would ban Florida sales of all but 23 tobacco-flavored vaping products sold by Big Tobacco companies is heading to the Senate floor despite public pushback. The measure (SB 1006) wouldn't explicitly limit retailers to selling those products. But it would prohibit sales of any vapes that have not received Food and Drug Administration (FDA) approval. And of some 26 million products submitted for approval, only 23 owned by RJ Reynolds, Japan Tobacco International and Altria, the parent company of Philip Morris, have received clearance.

"Up in smoke: THC caps for adult-use marijuana dead this Session" via Jacob Ogles of Florida Politics — As Florida voters await word on whether they'll have a chance to legalize recreational marijuana this November, they won't have to worry about a bill blunting the type of product available. An effort to cap THC levels in marijuana in a potential recreational market is dead this Legislative Session. The Senate Health Policy Committee bill (SB 7050) emerged earlier this month in the upper chamber. The effort to cap delta-9 caps had moved out of its first stop on a 7-3 vote.

— FOR YOUR RADAR —

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

"Florida's experiment with measles" via Daniel Engber of The Atlantic — Joseph Ladapo, the state's top health official, announced this week that the six cases of the disease reported among students at an elementary school in Weston, near Fort Lauderdale, do not merit emergency action to prevent unvaccinated students from attending class. That decision came off as brazen, even for an administration that has made systematic efforts to lower vaccination rates among its constituents over the past two years. Ladapo's letter acknowledges the benefits of vaccination, as well as the fact that vulnerable children are "normally recommended" to stay home. Still, it doesn't bother giving local parents the bare-minimum advice that all kids who are able should get their MMR shots, Dorit Reiss, a professor and vaccine-policy expert at UC Law San Francisco, told me: "I wouldn't have expected him, in the middle of a measles outbreak, to be willing to sacrifice children in this way."

"CBD could be banned in Florida if hemp bill passes, advocates warn" via Steven Lemongello of the Orlando Sentinel — CBD, a medication used by millions of Americans to battle a variety of illnesses and anxiety, could be banned entirely in Florida because of a bill that seeks to outlaw synthetic chemicals in hemp that can induce euphoria. Paige Figi, considered the "mother of CBD" in the U.S. because of her crusade to legalize what became known as Charlotte's Web, is attempting to sound the alarm about the bill. She is being joined by parents of children who desperately need the product and independent hemp growers worried their businesses would be devastated. "I just don't think the lawmakers are taking account of the millions of Floridians that are going to be medically affected by the removal of their health products," Figi said.

"Sunshine State looks to require some insurers to cover costs of skin cancer screenings" via Fresh Take Florida — Phyllis Revord, living just minutes from the Atlantic Ocean beaches on Florida's east coast, never used to worry about lying in the sun. She even used tanning beds in high school. It wasn't until 2020 when she came across a friend's Facebook post detailing her skin cancer journey, that Revord considered screening for skin cancer. Motivated by her friend's experience, Revord, now 27, scheduled an appointment with her dermatologist and ended up receiving the same diagnosis as her friend: melanoma. "Had I gone about my life with a tiny mole and just never gotten my skin checked, [the melanoma] could have completely spread to other areas — serious organs in your body," she said. Lawmakers in Tallahassee were poised this week to make it easier and cheaper for hundreds of thousands of Florida residents to undergo such potentially lifesaving screenings by ensuring that health insurance companies cover all costs.