Wednesday, March 27, 2024

Diagnosis for 3.27.24: Checking the pulse of Florida health care news and policy

Christine Jordan Sexton

March 27

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

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Lobbyists and health care providers are waiting anxiously for the Agency for Health Care Administration (AHCA) to finally announce who Florida is picking to oversee the state's multi-billion Medicaid system.

AHCA was expected to announce the winners of its latest Medicaid managed care contracts on Monday, but the agency has yet to publicly release the list of successful bidders.

"It's a wonder their server isn't crashing," one lobbyist quipped to Florida Politics Wednesday afternoon.

*When will AHCA make the announcement? Stay tuned ...*

According to AHCA, there were 4,806,358 people enrolled in Medicaid in February, the latest available data. Enrollment for the month was flat, with just a 0.14% increase over January enrollment.

The announcement could be a game changer for Medicaid-managed care plans and the enrollees they serve. Plans that aren't chosen are essentially locked out of the health care safety net program unless they acquire or merge with another health plan.

This is the third time the state has put its Medicaid Managed Care program up for competitive bid.

Florida law requires most Medicaid beneficiaries, from the cradle to the grave, to enroll in a Medicaid-managed care plan as part of the "Statewide Medicaid Managed Care" program.

Florida's existing managed care contracts expire Dec. 31, 2024, which means the new contracts need to be signed and executed soon.

To that end, AHCA released its invitation to negotiate (ITN) last April for so-called Managed Medical Assistance (MMA) and Long-term Care (LTC) benefits.

Stay tuned, the announcement is imminent.

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

— How soon is now? —

There is another deadline approaching.

The Florida Supreme Court must make a consequential decision between now and April 1 — Monday — on whether to allow two significant ballot initiatives on the November 2024 ballot.

If approved by voters, one of the proposed constitutional amendments would allow the sale and possession of recreational marijuana, a move that would rapidly be embraced by the state's already established medical marijuana industry. One of Florida's dominant medical marijuana companies, Trulieve, donated more than $40 million to finance the effort to get the measure on the ballot.

The court's review is centered around whether the amendment sticks to a single subject and if the ballot summary and title are misleading.

*The Florida Supreme Court has until Easter Monday to decide the fate of the recreational pot amendment.*

Attorney General Ashley Moody asked the court to block the marijuana amendment from the ballot, but the scope of questions during the Supreme Court hearing suggested that several justices were skeptical of her reasoning. The group behind the amendment — Smart & Safe Florida — has maintained it followed a roadmap laid out by the court when the Supreme Court permitted a medical marijuana amendment to make the ballot.

Gov. Ron DeSantis has already sounded off about what he calls the broad impact of the initiative although he also has suggested that he expects the Supreme Court to allow the measure to go before voters. Sixty percent of those voting on the amendment must say yes for the initiative to pass.

The expected court action comes right after the Florida Legislature passed a highly contentious bill to restrict the hemp industry. Some view this as a way to sideline a potential competitor to the soon-to-be burgeoning recreational marijuana market. The bill passed the House by a relatively narrow 64-48 vote, although it was unanimously passed by the Senate. There have already been calls for DeSantis to veto the bill.

— Abortion rights —

The other proposed amendment the court must review is an abortion rights measure that would block the state from prohibiting abortion up to the point of viability, which is usually around 24 weeks of pregnancy.

Moody has also asked the court to block this measure as well and, once again, there appeared to be pushback from some of the justices when they held oral arguments in early February.

The court's looming decision on the abortion rights initiative comes as the Supreme Court has yet to render a much-anticipated ruling on the fate of Florida's existing ban on abortions after 15 weeks of pregnancy.

*Justices appeared skeptical of the state's argument against placing the proposed amendment on the ballot.*

The Florida Legislature first approved the ban back in 2022 before the U.S. Supreme Court overturned Roe v. Wade, which had been the guiding precedent on when states could regulate abortion.

The legal challenge against the law, however, centers on whether the ban violates the state constitution and a privacy clause that was first approved by voters in 1980. That clause has been cited by the state Supreme Court when it struck down previous abortion laws passed by the Legislature. A decision to uphold the 15-week ban would presumably require the Florida Supreme Court to also overturn its previous rulings.

If the state Supreme Court does uphold the 15-week ban then a ban on abortions after six weeks would take effect 30 days later. Legislators approved the stricter ban in 2023 after the U.S. Supreme Court overturned Roe v. Wade.

— A 'fast one?' —

Florida's health care regulatory agency — now charged with tracking how much-uncompensated health care is provided to migrants in Florida — recently rolled out a new dashboard meant to give the public the answer to that question.

However, the Agency for Health Care Administration's new dashboard is missing some of the caveats that were provided in a mandatory report on the same subject delivered to legislators weeks earlier, including a finding that the agency was "not able to find any obvious correlation" between the amount of uncompensated care provided by hospitals and the level "of illegal aliens" who were treated at the facilities.

The legislative report also states that "high levels of uncompensated care are more associated with rural county status than illegal immigration percentages."

Those findings were labeled as "additional observations'' in the report submitted to the Legislature, but they don't appear in the report included on the agency's dashboard.

When asked, AHCA did not explain the differences between the legislative report and the one on the dashboard. AHCA said it was important to let taxpayers know that money was being spent on those in the country illegally.

*AHCA's new dashboard doesn't include the context provided in a report delivered to lawmakers.*

In a statement to Florida Politics, AHCA said the dashboard "highlights the $566 million dollar burden that illegal immigration has had on our health care system, which is designed to serve the citizens of the United States. Ultimately, taxpayers should not be forced to bear the cost of any amount of uncompensated care for illegal immigrants, and this dashboard well documents just how big that burden has become."

A spokesperson for the Florida Immigrant Coalition (FIC) said providing different reports to the public and the Legislature is "dishonest and deceitful."

"The state is trying to pull a fast one on us and, again, immigrants are the scapegoat. They should be ashamed of themselves; this level of trickery is not what Floridians deserve," said FIC spokesperson Adrianna Rivera.

Since taking office, DeSantis has pushed multiple measures to address illegal immigration, including a bill passed in 2023 that required hospitals to ask people about their immigration status. AHCA was required to submit a report detailing the findings to the Legislature by March 1.

The Legislature appropriated an additional $577,000 to AHCA in the 2024-25 budget to pay for staff and resources necessary for its migrant and nursing home data collection efforts.

Sen. Gayle Harrell, the chief health care budget negotiator for the Senate, said the appropriation was necessary to ensure AHCA had the staff it needed to collect the information.

"We have a significant number of individuals coming into this state who are illegal and we need to know exactly what that is. The federal government should be paying that and they are not," she said.

— Teaching crisis training —

There's an effort underway to better train select law enforcement officials to support people experiencing a mental health crisis.

Simply Healthcare Plans is teaming up with the Florida Sheriffs Association (FSA) and Carelon Behavioral Health to expand the Crisis Intervention Team (CIT) Training Coordinator Academy.

FSA recently held a CIT training session at its Tallahassee headquarters, where 28 sworn officers and civilian employees were given the resources and the skills they needed to host training sessions in their local communities.

*Training Coordinators after Graduating from the Crisis Intervention Team (CIT) Training Academy. Image via Simply Healthcare.*

The training emphasizes collaboration between law enforcement, mental health professionals, advocacy groups, and individuals with mental health concerns and their families.

"Simply Healthcare is honored to partner with the Florida Sheriffs Association and Carelon Behavioral Health to equip law enforcement to safely interact with individuals in mental health or substance use crises," said Dana Gryniuk, president of Simply Healthcare Plans. "By empowering law enforcement with the effective tools and training this program offers, we can connect Floridians with compassionate care during their greatest times of need."

FSA President and Nassau County Sheriff Bill Leeper thanked Simply and Carelon Behavioral Health for "graciously supporting our efforts to build safer, more resilient communities where Floridians can receive the support and care they deserve."

The FSA hopes to hold a second CIT Training Coordinator Academy in the late spring. More information here.

— RULES —

— AHCA announced an extension for its proposed amendments to Rule 59A-35.125 regarding the standards for the appropriate use of facial coverings for infection control at health facilities. The agency needs more time, according to the notice, to solicit public comment on the rules associated with this rulemaking effort. More here.

— AHCA announced an extension for its proposed amendments to Rule 59A-3.270 regarding patients' immigration status. More here.

— AHCA announced an extension for its proposed amendment to Rule 59A-8.0099 regarding home health aides for medically fragile children. According to the announcement, AHCA needs additional time to further develop and solicit public comment on the rules. More here.

— LOBBYISTS —

Meghan Hoza Hodde, Ken Pruitt, Mark Timothy Pruitt, The P5 Group: Nobi USA

— ETC —

— Liquid gold: The American Academy of Pediatrics recommends breastfeeding for the first 6 months of a baby's life and recently issued recommendations that outlined how breastfeeding babies up to 2 years of age impacts health. Although data from Florida show that encouraging women to start lactation is being done well throughout the state, by the time babies are about 6 months old, only half of mothers can continue lactation, often due to environmental challenges. A University of Florida press release notes that a new project at UF Health Shands Hospital called Maximizing Initiatives for Lactation Knowledge, or MILK+, aims to address these challenges. The proposal strives to help clinicians identify women at high risk for lactation failure and provide targeted interventions to promote lactation success beginning at their baby's birth, with the goal of increasing the number of postpartum women providing any human milk at discharge by 10% over a year.

— Who knew? Chronic itch leads to more than 7 million clinic visits annually in the U.S. and is among the world's 50 most prevalent conditions. But a new study by Gil Yosipovitch, M.D., director of the Miami Itch Center, and Santosh Mishra, Ph.D., a neuroscientist and associate professor at the North Carolina State University College of Veterinary Medicine, found that a B-type natriuretic peptide (BNP) plays a key role in chronic itch severity and can help to identify certain types of itch with a simple blood test.

— New rule: The Biden-Harris Administration unveiled a final rule aimed at protecting and improving how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). According to a press release the "Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes" rule will remove red tape and barriers to enrollment, update and build on the Affordable Care Act's coverage protections and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a modernized, less cumbersome enrollment process with reduced red tape, helping more people keep coverage.

— ROSTER —

— Qualenta Kivett, executive vice president and chief people and talent officer at Tampa General Hospital;Olesea Azevedo, senior vice president and chief health resource officer of AdventHealth; Ed Daech, chief health resource officer for UF Health Shands; Karen Frenier, senior vice president of human resources and chief nurse executive at Orlando Health; and Adriene McCoy, senior vice president and chief people officer for Baptist Health South Florida have been recognized by Becker's Hospital Review in its "84+ Chief Human Resource Officers (CHROs) and Chief People Officers to Know" list for 2024.

— Scott Crabtree, president and CEO of Lambeth House in New Orleans, has been named to the board of trustees for LeadingAge Southeast, the organization that represents senior living providers in Florida, Alabama, Louisiana and Mississippi.

— HCA Florida Orange Park Hospital announced the appointment of three new board members: Clay County Sheriff Michelle Cook, attorney David King, and Borland Groover Vice President Dinesh Madhok, M.D.

—I CYMI —

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

"Ron DeSantis pans 'phony narratives' from media about measles" via AG Gancarski of Florida Politics — Florida's Governor is irked by what he says is disproportionate coverage of measles outbreaks. From his personal social media account on X, DeSantis offered a snarky quote tweet of a post from one of his followers. The post suggested that coverage of an in-state school flare-up of the disease was more pronounced than that of an Illinois shelter for undocumented immigrants. The poster asserted that "there are 30+ cases of measles tied to an illegal immigrant shelter in Chicago but I haven't seen the same news coverage about this as the < 10 cases in Florida last month."

"Gov. DeSantis receives bill giving state regulatory control over food delivery app" via AG Gancarski of Florida Politics — Tallahassee may have something to say about what happens when you order food from popular delivery apps soon. DeSantis has received SB 676, which passed the Senate and House without a "no" vote this Session. It will become law unless he vetoes it. The bill, sponsored by Sen. Jennifer Bradley of Clay County, would relegate the regulation of "food delivery platforms" that corral orders from multiple restaurants to the state.

"Gov. DeSantis signs bill to keep suicide media, autopsy reports confidential" via Jesse Scheckner of Florida Politics — Autopsy reports for people who died by suicide and media depicting the act will be shielded from public view under a new Florida law. The measure (SB 474), which DeSantis quietly signed, exempts photos, videos and audio recordings of people taking their own lives from general public records requests.

"Gov. DeSantis signs bill requiring DNA samples from all Florida inmates" via Jesse Scheckner of Florida Politics — DeSantis signed legislation that could lead to cold case closures across the Sunshine State. The bill (HB 533), which goes into effect immediately, requires all Florida inmates who don't already have DNA in the state's database to provide a sample by Sept. 30. State law already requires many individuals arrested or convicted of certain offenses to submit DNA samples, including those charged with sexual assault, indecent exposure, murder, robbery, battery, burglary, felony firearm violations and theft.

"Gov. DeSantis signs Kathleen Passidomo's signature 'Live Healthy' package" via Christine Jordan Sexton of Florida Politics — The Governor signed a quartet of bills that infuse $1.2 billion into Florida's health care workforce so the state can prepare for a burgeoning and aging population. Live Healthy does not include a Medicaid expansion as allowable under the federal health care law often referred to as Obamacare. Passidomo repeatedly, throughout the 2024 Session, said expanding Medicaid would not guarantee access to health care. She reiterated those comments at the bill signing.

— FOR YOUR RADAR —

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

"Thousands of Florida kids lost Medicaid. Now some have no coverage" via Joe Mario Pedersen of Health News Florida — Early estimates for disenrollment predicted that between 900,000 and 1.75 million residents would no longer be eligible. It was also predicted that kids would make up a large bulk of those terminated from coverage. It's been one year since Florida began sending letters of Medicaid redetermination. About 979,000 people have been disenrolled, and as predicted, children have felt the impact much more. Since the start of disenrollment last year, nearly 460,000 kids have lost Medicaid coverage. Only about 49,000 have successfully migrated to Florida KidCare, the state's Children's Health Insurance Program, also known as CHIP. It is unclear what has happened to the vast majority of children.

"Supreme Court's anti-abortion conservatives could restrict abortion pills sent by mail, even in blue states" via the Tribune News Service — The Supreme Court's anti-abortion majority is set to consider whether to order a reversal in U.S. drug laws and restrict women from obtaining abortion medication at pharmacies or through the mail. A ruling to restrict the most common method of abortion would limit the rights of women in California and other states where abortion remains legal. "We may have thought we were protected because California is supportive of abortion, but this decision [on abortion pills] will be national in scope," said Dr. Daniel Grossman, a professor of obstetrics at UC San Francisco. Whether they prevail now depends on the three justices appointed by Trump who were crucial to overturning Roe vs. Wade: Justices Neil M. Gorsuch, Brett M. Kavanaugh and Amy Coney Barrett. If all three join with Justices Clarence Thomas and Samuel A. Alito, they could roll back the use of abortion pills.

"HIV patients in Panhandle caught in the middle of nonprofits' contract dispute" via T.S. Strickland of WUWF — In late February, several dozen demonstrators rallied outside the offices of Okaloosa AIDS Support and Informational Services, also known as OASIS, in downtown Pensacola. It was a dramatic escalation in a conflict that has pitted OASIS, a small regional nonprofit, against the world's largest HIV and AIDS health care provider, the AIDS Healthcare Foundation, also known as AHF. AHF has been criticized in the past for political advocacy work that some have argued has a tenuous connection to its mission, as well as its aggressive expansion tactics. AHF has filed dozens of lawsuits in jurisdictions across the country, and they are represented by one of the most powerful lobbyists in Florida, Brian Ballard, who has close ties to DeSantis and former President Trump.