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

— Anticipation is keeping us waiting—

Two major federal lawsuits dealing with Florida’s safety net health care program and subsidized children’s health insurance programs remain in a holding pattern.

It’s been nearly two weeks since a federal judge postponed a trial challenging how the administration of Gov. Ron DeSantis has removed people from the Medicaid rolls.

The trial was delayed because U.S. District Judge Marcia Morales Howard had a death in her family. A status conference to discuss when the trial can be rescheduled has yet to be held.

The Medicaid lawsuit filed in Jacksonville stems from Florida’s actions after the state resumed determining whether or not people were still eligible for coverage. During COVID-19, the federal government increased funding to states for Medicaid but mandated that the states could not remove people while the emergency was in place.

The Medicaid lawsuit filed in Jacksonville centers on whether or not the administration properly notified individuals about their termination from the safety net health care program. The lawsuit asks a judge to prevent Florida from using its current notice process as well as reinstate to Medicaid those previously removed until a new more detailed process is put in place.

Meanwhile, a key decision is still pending in Florida’s lawsuit against the Biden administration over guidelines for subsidized children’s health insurance programs.

Florida is challenging a federal requirement that requires that children remain continuously enrolled in the program known as Florida Kidcare even if the families have stopped paying premiums. The Joe Biden administration maintains the requirement was mandated by Congress but Florida says federal authorities are misinterpreting the law.

In mid-April Judge William Jung held a hearing on Florida’s request for a preliminary injunction in the case. Jung asked both sides to submit proposed orders on the motion but he has yet to render a ruling.

Last week the Biden administration filed a lengthy response to the initial lawsuit and asked that it be dismissed.

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— Good news —

The number of Americans without health insurance at the end of last year held steady at 7.7% although the data does not fully reflect the number of people who signed up for health insurance coverage during the recent open enrollment period for Obamacare.

Federal authorities late last week released data that showed the number of those without coverage had stayed constant for the final six months of 2023 — a figure that was below the 8.3% uninsured rate for the final quarter of 2022.

Health and Human Services Secretary Xavier Becerra touted the new numbers as proof of successful efforts by the Biden administration to provide health insurance coverage.

The overall national figure is notable given that many states — including Florida — last year began a process of “unwinding” where they were allowed to remove people from Medicaid because they were no longer eligible for the safety-net health care program. States were required to freeze Medicaid rolls during the public health emergency that occurred due to the COVID-19 pandemic.

But the new uninsured rate also does not capture the impact of Obamacare enrollment. A record 4.21 million Floridians signed up for health insurance through the federal exchange during the period that ended in January.

Florida, which has had one of the higher uninsured rates in the nation, led the nation in Obamacare enrollment. More than 21 million Americans obtained insurance through Obamacare during the open enrollment period.

—DeSantis joins RGA letter—

DeSantis joined 23 other Republican Governors signing onto a letter to Biden stating their opposition to proposed amendments on the World Health Organization’s International Health Regulations and a New Pandemic Treaty.

“We, as governors of our respective states, stand united in opposition to two proposed instruments currently under negotiation that would purport to grant the World Health Organization (WHO) unprecedented and unconstitutional powers over the United States and its people. These Proposed changes could drastically change the role of governors in response to their charge as the state health officials,” reads the May 22 letter from the Republican Governors Association.

DeSantis went from a first-time Governor with a year’s experience under his belt, to a nationally recognized name due in part to his response to the COVID-19 pandemic.

While DeSantis was an early proponent of the vaccine and — unlike the federal government — made getting the vaccine to the senior population the No. 1 priority, he pivoted his position, suing the federal government for its vaccine mandate policies.

The letter was signed by 24 of the 27 Republican Governors.

“As governors, we affirm that public health policy is a matter reserved for the states, not the federal government, and certainly not international bodies like the WHO. We are committed to resisting any attempts to transfer authority to the WHO over public policy affecting our citizens or any efforts by the WHO to assert such authority over them.”

—More needs than desires?—

Florida health care regulators earlier this year said the state needed an additional 702 nursing home beds by January 2027.

Two months after making the announcement, the state received nine CON applications from vendors for 560 new community nursing home beds, 269 of which are applications to convert sheltered beds to community nursing home beds.

The applications come at a time when, according to Bloomberg News, nursing home debt default rates in the Sunshine State hit 18%, well above the national 8% average.

Pilar Carvajal, CEO of Innovation Senior Living in Winter Park, told Bloomberg, “We are headed into a train wreck.”

Florida regulates new nursing beds and construction through the certificate of need (CON) program. There are four CON batching cycles annually, two of which are for skilled nursing facilities or new institutions for people with development and intellectual disabilities and the other two for hospice programs.

Lawmakers considered making changes to state tort laws to provide legal protections to assisted living facilities, many of which are part of larger long term care systems with a continuum of providers, but ultimately made no changes.

While the long term care providers may have fallen short on their efforts to alter how claims are filed and litigated, the industry walked away a winner with record-setting double-digit increases in Medicaid reimbursements.

— New dental protections —

Hard-fought changes pushed by the Florida Dental Association (FDA) will soon become a reality after reality this summer now that DeSantis signed SB 892.

The new law puts dentists in the driver’s seat when it comes to their insurance reimbursements, requiring insurers and managed care plans to get dentists’ advance consent to provide ACH payments by Jan. 1, 2025.

A dentist’s consent may be given through an email that bears the electronic or digital signature of the dentist. As an alternative, express consent can be provided by checking a box indicating consent.

Third-party payors that reimburse providers via an Automated Clearing House (ACH) transfer cannot charge a fee to transmit the payment unless the dentist has consented to the fee.

The law also updates Florida’s insurance codes to make clear that once prior authorization is obtained an insurer cannot subsequently deny a claim unless the claim was denied because, among other reasons, another payor is responsible for payment; the claim was submitted fraudulently; or the prior authorization was based in whole or material part on erroneous information provided to the health insurer by the dentist, patient, or other person not related to the insurer or the person receiving the procedure was not eligible to receive the procedure on the date of service.

“This legislation will address a key issue that is affecting too many Florida patients – denial of coverage for dental treatment services that had been previously authorized by their dental plan,” said Dr. Beatriz Terry, president of the FDA. “This new law will help ensure patients receive the dental benefits they are paying for.”

SB 892 was one of a spate of policy victories for the FDA in the 2024 Session which also saw Medicaid reimbursement increases for dentists.

HB 855 which cracks down on orthodontic telehealth, was sent to the Governor Tuesday.

The legislation requires an in-person examination and “a dentist of record to remain primarily responsible for all dental treatments for a patient treated through telehealth.

—Go Gators—

The University of Florida Health has been selected by the Centers for Disease Control and Prevention to lead a program that could reduce the health disparity gap in some Jacksonville communities by connecting patients with community pharmacists for help managing high blood pressure.

Dubbed the Hypertension Pharmacists’ Program the initiative is scheduled to start this summer with the goal of expanding access to blood pressure care for the city’s medically underserved, predominantly Black communities.

Nearly half of American adults are affected by high blood pressure or hypertension.

Blacks suffer disproportionately, data show.

The program aims to increase treatment for high blood pressure by embedding clinical pharmacists within a patient’s primary care team. The effort, facilitated by the UF Health Jacksonville Office of Community Engagement, is a collaboration among the UF Health Total Care Clinic – Jacksonville, the UF College of Pharmacy and Panama Pharmacy, and it will allow patients to see a specially trained pharmacist at a community pharmacy and seek individualized care and education.

The CDC reports that nearly 90% of Americans live within five miles of a community pharmacy, making pharmacists the most accessible health care provider for most people. Community pharmacists can also make medication recommendations and lifestyle adjustments to help patients better manage the disease.

“Hypertension repeatedly shows up in the triannual Community Health Needs Assessment as a significant health factor and concern in our community. Being able to provide health resources through a collaborative effort such as this is a fantastic opportunity for our patients and for the continuum of care,” says Ann-Marie Knight, M.H.A., FACHE, Vice President of community engagement for UF Health Jacksonville.

— Art awards—

The Florida Health Care Association (FHCA) has picked a winner for its 2024 Long Term Care Photo Contest.

Shout out to Sabal Palms Health Care Center in Largo, which took the top spot for its photo “Veterans Wall of Honor,” taken by Sabal Palms Director of Life Enrichment Lauren Evarts.

FHCA gave the facility a $500 contribution for a social event for residents and staff. Evarts will also receive a $50 gift card for her submission.

“We are inspired by the outpouring of submissions we received for this year’s long-term care photo contest,” said FHCA CEO Emmett Reed. “These photos, taken by caregivers, facility staff, and volunteers, capture the unique and special bonds shared in our long-term care communities. The stories shared through the pictures showcase the amazing history and relationships housed in each of our centers across the state. We are overjoyed each year to receive these submissions and learn more about the lives being changed through the kindness cultivated in our centers.”

More than 200 photos were entered into this year’s contest, which focused on the theme “Cultivating Kindness.” The contest is sponsored by Incite Strategic Partners.

The announcement coincided with National Skilled Nursing Care Week.

The second-place winner is “Sharing is Caring” by Island Lake Center in Longwood, submitted by recreation assistant Freida Bratcher. The photo features residents who have been married for 50 years sharing a slice of pizza on National Pizza Day.

Bratcher said the couple “have always been inseparable. I love their love story, and I have always seen how loyal she is to her husband, how his face lights up when he sees her, and how she prides herself on spending time with him every day.”

“100th Birthday Party” by Bridgewater Park Health and Rehabilitation in Ocala placed third in the photo contest. Activity Director Joy Dean submitted the photo of a resident’s 100th birthday party surprise birthday celebration.

“I was inspired to take her picture because I happened to look over and see this normally reserved and humble lady, just positively glowing with happiness and love, and with her crown and sash I thought she looked like a queen and wanted to always keep that radiant memory with me,” said Dean. “I look forward to seeing her every day and I like to think the feeling is the same for her.”

The winning photos will be displayed during FHCA’s 2024 Annual Conference & Trade Show in Orlando. To read more about this year’s Long Term Care Photo Contest, click here.

— RULES —

Stanley C. Haimes, M.D., has petitioned the Board of Medicine asking whether he is allowed to refer requests for an independent medical examination (IME) report and supplied medical records to the entity that paid for the evaluation or is he required to release directly and without delay to the individual being evaluated, copies of the report and supplied medical records. The Board will consider this petition at its June 7 meeting in Tallahassee.

A copy of the Petition for Declaratory Statement may be obtained by contacting: Paul J. Vazquez, J.D., Executive Director, Board of Medicine, 4052 Bald Cypress Way, Bin #C03, Tallahassee 32399-3253, or [email protected].

— LOBBYISTS —

Michael Corcoran, Jacqueline Corcoran, Matt Blair, Will Rodriguez, Andrea Tovar, Corcoran Partners: Florida Community Care and Independent Living Systems.

— ETC —

— The American Medical Association publication, JAMA Network Open, this week published the findings of a new study led by a University of Florida College of Public Health and Health Professions researcher that shows a nexus between high fluoride levels in pregnant women and neurobehavioral problems in their children. It is believed to be the first U.S.-based study to examine associations of prenatal fluoride exposure with parent-reported child neurobehavioral issues, which include symptoms of anxiety, difficulty regulating emotions and other complaints, such as stomachaches and headaches. The findings are based on an analysis involving 229 mother-child pairs living in a U.S. community with typical fluoride exposure levels for pregnant women in fluoridated regions in North America.

— Attorney General Ashley Moody’s Medicaid Fraud Control Unit (MFCU) arrested the owners of A River’s Journey home health care agency, which has residential home care facilities located in Yulee and Jacksonville. Latrena Marie Thomas and Donald Ray Adams II were arrested for allegedly billing Medicaid $1.6 million for 30 patients who qualify for Medicaid under the Medically Needy program. According to the investigation, Thomas and the agency hired employees who were not licensed as certified nursing assistants, several of whom would have failed the Level 2 background screening that is required by the Florida Agency for Health Care Administration, to provide hands-on personal care to Medicaid recipients. Thomas did not have a director of nursing on staff as required by law to provide oversight of the licensed practical nurses and other staff employed, falsified work-related documents, and billed for around-the-clock care. Moody’s MFCU will prosecute the case through the State Attorney’s Office for Florida’s 4th Judicial Circuit.

— In a letter to U.S. Sen. Bernie Sanders and Rep. Brett Guthrie, who chair Committees overseeing the U.S. Center for Medicaid and Medicare Services, CFO Jimmy Patronis warned that the Obamacare Marketplace does not adequately guard against bad actors who switch policyholders’ health insurance plans without consent to collect commission. “Policyholders are getting plans they didn’t want or ask for,” Patronis said. “Thanks to the weak security measures of the Marketplace, Floridians are being signed up for health policies in different states, then getting penalized by the IRS because they made too much to qualify for plans. This fraud can only occur through a Marketplace that’s got more holes in it than a cheap slice of Swiss cheese.”

—A cyberattack on Change Healthcare has representatives in senior-heavy districts concerned for constituents. Reps. Vern Buchanan, a Longboat Key Republican, and Bilirakis sent a letter to Health and Human Services Secretary Beccera detailing concerns about the federal response. Change Healthcare, which supports 14 billion clinical, financial and operational transactions each year, suffered the attack in February. While the Florida lawmakers expressed gratitude the service has worked with health care providers, many still suffer cash flow problems, according to the letter.Mary Mayhew, president and CEO of the Florida Hospital Association, said the attack impacted nearly every hospital in the state, including more than 100 that rely solely on Change Healthcare for billing.

—ROSTER—

Eric Lawson, the CEO of HCA North Florida Regional Hospital, has been appointed to the Gainesville Regional Utilities Authority. held multiple executive positions at HCA over the last 30 years. Lawson earned his bachelor’s degree in accounting from Tennessee Technological University.

Sha Edathumparampil was named the chief digital and information officer at Baptist Health South Florida In this role, Edathumparampil will drive Baptist Health’s digital transformation efforts while enhancing technology support and customer service for physicians, staff and patients. Edathumparampil joined Baptist Health three years ago from American Century Investments, where he was chief data officer and vice president of technology. He has also held technology and digital leadership roles at BMO Financial Group, The Walt Disney Company, Sabre Inc., and Fidelity Investments.

—ICYMI—

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

“Health care union backs ‘dedicated advocate’ David Richardson for Miami-Dade Tax Collector” via Jesse Scheckner of Florida Politics — A union representing more than 6,200 local health care workers is throwing its support behind former state lawmaker and Miami Beach Commissioner David Richardson’s bid to be Miami-Dade’s next Tax Collector.Richardson’s campaign announced an endorsement from SEIU Local 1991, the exclusive bargaining representation for nurses, physicians and other health care professionals at county-run Jackson Health System.

“Tampa General’s John Couris appointed to Florida’s Healthcare Innovation Council” via Peter Schorsch of Florida Politics — Senate President Kathleen Passidomo appointed Tampa General Hospital President and CEO John Couris to the newly established Florida Healthcare Innovation Council last month.The Council was recently created to address issues facing the health care industry with fresh perspectives from leaders and innovators across the industry. The Council was established by Senate Bill 7018, proposed by the Senate’s Health Policy Committee and shepherded to the finish line by health care champion Sen. Gayle Harrell in the Senate and Rep. Karen Gonzalez-Pittman in the House. The bill passed with overwhelming support from both chambers and was signed by the Governor on March 21.

“Florida Behavioral Health Association: Housing is an integral part of serious mental health treatment,” via Christine Jordan Sexton of Florida Politics — Top DeSantis administration officials appeared in St. Petersburg to tout the significant spending increases Florida has made for mental health fundingThe administration also promoted its successes with housing programs meant to help people with a serious mental health condition successfully live, work and play in the community in which they live. Department of Children and Families Secretary Shevaun Harris said the Legislature has in recent years increased the amount of recurring state dollars spent on housing for people with serious mental health illness. We’ve seen a 308% increase between state Fiscal Year 22-23 and state Fiscal Year 23-24, increasing our funding from $6.1 million to $25.2 million, respectively.”

“Pregnancy, parenting info soon coming to a tax-supported website near you” via Chirsitne Jordan Sexton of Florida Politics — Look for a state supported online pregnancy and parenting resource hub no later than Jan. 1, 2025, under a new law that takes effect July 1.The legislation (HB 415), sponsored by Republican Rep. Berny Jacques, also includes a one-time $466,200 appropriation to cover the cost of for the state to contract with a third party to develop the website. While the money is appropriated to the Department of Health (DOH), the law requires the agency to collaborate with the Department of Children and Families and the Agency for Health Care Administration to work collectively on the development of the website.

—FOR YOUR RADAR—

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

“Sarasota Memorial Hospital Board will consider adopting Joseph Ladapo’s anti-vaccine guidance” via Earle Kimel of the Sarasota Herald-Tribune — The Sarasota County Public Hospital Board will weigh a proposal by Board member Vic Rohe that the hospital embrace assertions by Surgeon General Ladapo that COVID-19 vaccinations are risky and inappropriate for human use when it meets at 2 p.m. Tuesday. Federal health officials say Ladapo’s position is contrary to science and potentially deadly. In January, Rohe asked for the proposal — a five-page motion that he said members of the community handed him — to be placed on a future agenda.

“Fentanyl crisis: Overdoses stop rising in Lee County, but challenges remain” via Dan Glaun of the Fort Myers News-Press — The number of fatal overdoses in Lee County appears to have plateaued, even as death rates remain near historical peaks. Overdose fatalities peaked with 296 deaths in 2020. Those numbers declined to 295 in 2021 and 293 in 2022. “Many have cited this as sort of a glimmer of positive news,” said Dr. Denise Torres, an addiction medicine specialist with Lee Physician Group. “The curve has sort of flattened.” But Torres also warned against complacency. In 2015, before fentanyl had saturated the Lee County drug market, there were 86 opioid overdose deaths — less than a third of recent totals. Opioids remain by far the most lethal class of drugs in Lee County, accounting for 90% of overdose deaths in 2022.

“Former SMH Board Chair appointed to fill unexpired term in at large Seat 3 until November” via the Sarasota Herald-Tribune — Former Sarasota County Public Hospital Board Chair William “Bill” Noonan was appointed to temporarily fill the vacant at large Seat 3 position on the Board. The seat has been vacant since mid-April when Britt Riner stepped down to focus on a new role advocating for parents and children statewide. Noonan will hold the seat until the General Election in November, when voters will pick a new Board member in a race set to include Democrat George Davis and the winner of an Aug. 20 Republican Primary between Pam Beitlich and Mary Flynn O’Neill. The Hospital Board sets the strategic direction of the Sarasota Memorial Health Care System. Four seats on the nine-member Board are on the ballot this year.

—PENCIL IT IN—

Thursday

Happy birthday to Sen. Ana Maria Rodriguez!

8 a.m. — 2024 Florida Voices for Health Summit at the Space Coast Health Foundation1100 Rockledge Blvd, Rockledge, FL More information on tickets here.

2 p.m. — AHCA’s Office of Health Information Exchange and Policy Analysis hosts an education session on thow Florida health information exchange works with crisis stabilization units and other behavioral health providers. Register here.

Friday 

8 a.m. — 2024 Florida Voices for Health Summit at the Space Coast Health Foundation1100 Rockledge Blvd, Rockledge, FL More information on tickets here.

Monday

Happy Memorial Day!

Tuesday 

3:30 p.m. — Rep. Anna V. Eskamani, Geori Seldine, the executive director of Florida’s Children First, and Kyle Johnson, Florida Youth SHINE’s statewide chair and Orlando Chapter member discuss the foster care system in the state of Florida, current programs and services, and ways it can be improved.The event will be streamed on Facebook Live. RSVP here.

Wednesday 

Happy birthday to Reps. Daryl Campbell and Kim Berfield!

10 a.m. — The Blood Clot and Pulmonary Embolism Workgroup meets. Register for the meeting here.

11:30 a.m. — The Capital Tiger Bay Club is hosting a 2024 Leon County ‘State of Public Safety’ panel at a lunch program at the Donald L. Tucker Civic Center. Capital Tiger Bay Club member and attorney Liz Desloge Ellis will moderate the panel. Donald L. Tucker Civic Center, 505 West Pensacola St. Tallahassee.

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

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