Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics. HCAF distributes this newsletter to our members each week to provide the latest health policy news, views, and happenings. This newsletter is published by FloridaPolitics.com and republished with permission.

May 2, 11:59 p.m. That’s the deadline for Medicaid home and community-based providers to submit information to the state, including signed agreements, and tap into supplemental Medicaid payments, a letter obtained by Florida Politics shows.

The letter shows that the state put a $1 million aggregate cap on the total supplemental Medicaid payments the largest providers of home and community-based services could receive. This funding is split evenly between two grant categories: provider stipends and one-time retention payments.

Home- and community-based providers who provide the least care can tap into $4,000 in supplemental Medicaid payments for the two grant categories.

However, there is no set dollar amount for mid-size providers in the formula. Instead, a uniform percent increase of 46.82% and 28.6% will be applied to base payments to determine the amount of the stipend and retention grants, respectively.

The distribution formula, which seemingly benefits smaller and mid-sized providers, had not been made public before last week when the state Agency for Health Care Administration (AHCA) announced it was awarding nearly $503 million in enhanced payments to nearly 2,000 providers that had applied for the grants.

According to the correspondence, providers must upload to the “budget portal” the signed letter of agreement as well as a detailed spending plan before payment is made.

Florida’s home- and community-based Medicaid providers have been waiting for weeks for word about the grant awards. The state, on February 15, told the federal government it wanted to have the money distributed by the end of March.

The supplemental Medicaid funding was made possible by the American Rescue Plan, pushed by President Joe Biden.

The state is reopening the window of opportunity for providers that use 1099 staff to submit applications for the funds. Those providers will have until May 20 to submit a grant application to the state.

After Twitter and Facebook blocked former President Donald Trump from their platforms following the January 6, 2021, storming of the U.S. Capitol by Trump supporters, Governor Ron DeSantis prioritized cracking down on social media companies.

DeSantis and the Republican-dominated legislature passed a law that partially sought to prevent large social-media platforms from banning political candidates from their sites. It also required companies to publish and consistently apply standards about issues such as banning users or blocking their content.

But the tech industry went to court, arguing that the law violated First Amendment rights. And before the law could take effect, U.S. District Judge Robert Hinkle issued a preliminary injunction against the measure, which he described as “riddled with imprecision and ambiguity,”

"The legislation now at issue was an effort to rein in social-media providers deemed too large and too liberal. Balancing the exchange of ideas among private speakers is not a legitimate government interest,” Hinkle wrote in his June 2021 decision.

The state appealed Hinkle’s ruling, and a panel of the 11th U.S. Circuit Court of Appeals will consider the case Thursday during a hearing in Montgomery, Alabama.

Florida health care regulators have given a Destin nursing home another week to transfer its 100-plus residents to different facilities before the state temporarily shutters the facility.

Noting that protective measures had been put into place to protect the residents from danger, AHCA Deputy Secretary Kimberly Smoak issued an order on April 22 giving the Destin Healthcare and Rehabilitation Center until May 2 to transfer more than 100 residents from the building.

”At the moment of this order, the facility is no longer understaffed. Whether the staffing issue has been permanently corrected so that the facility will be in compliance for the long term remains to be determined,” the order reads. “At the current time, however, temporary protective measures have been put in place to at least address the present immediacy of the danger to the point where the suspension date of the license may be briefly extended in order to better accommodate the safe and orderly discharge of the nursing home residents."

According to the April 22 order, the nursing home management — which includes a new interim director of nursing and an interim chief executive officer — told the agency two days earlier there weren’t enough open nursing home beds in Okaloosa County, where the home is located, to transfer all the residents by April 25 as first ordered by the agency.

The agency estimates that there are between 40 and 50 available nursing home beds. AHCA has not provided Florida Politics with the number of residents who have been transferred from the facility since the emergency order was issued on April 16.

But according to the latest order, the facility’s “census has decreased little,” and “none of the decrease was due to the transfer of a resident to another nursing home.”

Smoak ordered the facility to “expedite the resident discharges and provide the agency with a daily status report on all the residents and the state's actions to discharge them. The reports must include the identity of the residents and when and where they were discharged. Moreover, the names of the caregivers and health care practitioners for each resident must also be provided to the state.

The looming departure of Senator Manny Diaz from the Florida Legislature ensures that the Senate’s primary health care committee will have new leadership — and likely new priorities during the next legislative session.

DeSantis announced this week that he recommends that the Hialeah Republican become the state’s next education commissioner. Education Commissioner and former House Speaker Richard Corcoran is stepping down from the job at the end of this month.

Diaz has spent the last two years as chair of the Senate Health Policy Committee, which placed him in a leadership position to help decide what health care legislation advanced in the Legislature. Senate President Wilton Simpson’s decision to tap Diaz — who had previously been a committee member — was somewhat unexpected given Diaz’s background as a high school teacher and then a top administrator with a private college.

In this past Session, Diaz engaged in a tug-of-war over telehealth and whether physicians could remotely prescribe certain regulated medications. Diaz and the Florida Senate wanted to allow physicians to use audio-only telephone calls, but House Republicans were opposed, and the bill passed without that provision included. At the end of Session, Diaz said that he and other senators were “committed” to including the audio-only option next year.

There was no guarantee that incoming Senate President Kathleen Passidomo would have kept Diaz — who has only been in the Senate for four years — as chair of Health Policy. Passidomo could also choose to change the committee structure and its scope.

But Diaz’s departure guarantees an opening for the Senate’s top health care spot, which is a highly sought post because it brings a fair amount of campaign support from Florida’s health care industry.

Currently, four other Republicans on the Health Policy committee are running for re-election: Jason Brodeur, who is now the vice-chair; Ben Albritton, Dennis Baxley, and Ileana Garcia. Senator Aaron Bean is on the committee, but he is term-limited and is leaving the Senate.

Past protocol would suggest it is unlikely Polk County Republican Albritton would be chair since he is in line to succeed Passidomo as President. The incoming President often — but not always — commands powerful committees such as the rules or appropriations committees ahead of their two-year term. Brodeur is interested in health policy issues and, while in the House of Representatives, chaired the House health care spending committee and served on health care policy committees.

Florida health care regulators don't think Florida needs the construction of any new nursing homes or long-term care institutions next year. But the state received letters of intent from three providers that want to build them anyway.

Pensacola Real Estate Holdings I, LLC said it intended to build a new 20-bed community nursing home in Bay County. Jupiter Opco LLC said it intended to create a new 90-bed community nursing home in Palm Beach County. And Arbor Village Home said it plans to build a new 12-bed intermediate care facility for the developmentally disabled in Indian River County.

Health care regulators announced on April 1 that there is no additional need for new nursing homes beds to be built next year. A published need is the first step in a regulatory program known as a certificate of need (CON).

Providers who want to offer services regulated by CON must show a need for the care. They also are required to submit letters of intent notifying the state they wish to provide the services. Letters of intent are not binding but are a necessary step in the CON process. May 18 is the deadline for CON applications to be submitted.

And in other CON news, Sunland Center is transferring 16 intermediate care facilities for individuals with developmental disabilities (ICFDD) beds from Building II on its Marianna campus and establishing them in Building IV. AHCA announced the addition of the beds on April 21.

Florida’s COVID-19 case count continues to tick slightly higher, coming close to matching levels seen in February, but still far below the surge in December and January.

There were 20,860 infections reported during the week that ended on April 22. Back in February, the case count was nearly 26,000. The weekly number of new cases had fallen to slightly more than 8,000 in mid-March.

The latest report from the Florida Department of Health (DOH) — which is released every two weeks now — also shows that the positivity rate is inching upward. In mid-March, the new case positivity rate had fallen to just 1.9%. The rate had risen to 6.1% by the week that ended on April 22.

During the two-plus years since the pandemic started, nearly 5.9 million Floridians have gotten infected — and 73,830 people have died.

While the case count is trending slightly higher, the number of those hospitalized due to COVID-19 remains low as well. As of Sunday, there were somewhat less than 1,000 hospitalized in the state, according to data maintained by the U.S. Department of Health and Human Services (HHS) — or less than 2% of all hospital beds available.

DOH reported that more than 59,000 vaccine doses were administered in the past week, dropping from late March to early April when more than 100,000 doses were handed out. The department reported that the overwhelming majority of these — more than 47,000 — were additional doses or booster shots. In late March, the Food and Drug Administration (FDA) authorized a second booster shot for those 50 and older and those who are immunocompromised.

The Board of Medicine proposes amending Rule 64B8-30.003 to clarify and modify the incorporated application form relating to questions regarding malpractice and settlement agreements. More here.

The Board of Medicine proposes amending Rule 64B8-9.012 to update the overall standards of practice for prescribing medication for the treatment of obesity in children and adults and allows for the use of telemedicine for such prescribing. More here.

The Board of Osteopathic Medicine proposes amending Rule 64B15-6.003 to clarify and modify the incorporated application form relating to questions regarding malpractice and settlement agreements. More here.

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

— Elders at risk: State health care regulators have banned a Naples nursing home from accepting any new residents, or readmitting existing residents, into its facility after state regulators discovered more than 10% of the residents had developed pressure ulcers while living there. One resident had to have an upper leg amputee because of the wounds.

— Public concern No. 3: COVID-19 slipped to No. 3 on the list of what Floridians are most concerned about, according to a University of South Florida (USF) survey. But most of the state’s residents remain on the lookout for a surge of cases in the months ahead.

— Good news: The Department of Agriculture (USDA) announced the Marianna Nursing Home, and Madison County Hospital are receiving grants for upgrades. The nursing home is getting more than $141,000 to build a new nurse call station, and the hospital is getting $1 million for infrastructure improvements. The Community Facilities Emergency Rural Health Care Grants program grants help rural hospitals and health care providers implement telehealth and nutrition assistance programs, increase staffing to administer COVID-19 vaccines and testing, build or renovate facilities and purchase medical supplies.

— One more shot: Florida Medicaid officials are reopening the window of opportunity for providers that use 1099 staff to submit applications for supplemental Medicaid funds. Those providers will have until May 20 to submit a grant application to the state.

Dr. Mark Roh was named Lee Health’s new chief physician executive of oncology services. Before joining Lee Health, Roh most recently served as president of Orlando Health University of Florida Health Cancer Center. As president, he orchestrated strategic growth initiatives and supervised a 675-person team, including 60 oncologists.

Candice Schwartz, M.D., has joined the Maroone Cancer Center at Cleveland Clinic’s Weston Hospital. She earned her medical degree at Wake Forest School of Medicine in Winston-Salem and completed the internal medicine residency at Rush University Medical Center in Chicago. Schwartz completed a fellowship in hematology/oncology at the University of Illinois at Chicago, where she was honored as chief fellow.

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

—"New WH coordinator not worried about BA. 2 surge, says hospitalizations remain low" via Tom Howell, Jr., of The Washington Times — White House COVID-19 coordinator Ashish Jha said Sunday the U.S. can weather a surge in coronavirus infections fueled by the BA.2 variant, citing hospitalizations that remain at pandemic lows, though he acknowledged the frustration of parents who want to see a vaccine for their youngest children.

—"HCA Healthcare shareholders rally against political donations to Gov. DeSantis" via Cindy Krischer Goodman of the South Florida Sun-Sentinel — Employee and union shareholders of HCA Healthcare, the largest operator of hospitals in Florida, rallied at the company’s annual meeting last week for improved reporting around its political spending and lobbying. The shareholders said research into political contributions revealed HCA had given more than $7 million to conservative political action committees in Florida that donated at least $2 million to Gov. DeSantis' campaign ― $1.5 million of that was in 2022.

—"Why cheap, older drugs that might treat COVID-19 never get out of the lab" via Arthur Allen of Kaiser Health News — In March 2020, Dr. Joseph Vinetz left the contemplative world of his Yale University infectious disease laboratory and plunged into the COVID-19 ward at Yale New Haven Hospital, joining an army of health care workers who struggled to treat the deadly viral disease. There were no drugs against COVID-19 and no way to predict which infected patients would develop pneumonia or fall into an inflammatory tailspin leading to severe illness or death. In desperation, Vinetz and countless other doctor-scientists trawled the literature for existing medicines that might help.

—"There’s a meningitis outbreak in Florida. Here’s who is at risk and what you need to know" via Daniel Chang, the Miami Herald — So far this year Florida has confirmed 21 cases of meningococcal disease, far outpacing annual averages, said state health officials, who are encouraging high-risk groups — including gay and bisexual men, people with HIV and college students — to get vaccinated against the often severe and sometimes deadly illness.

—"Ageism: A ‘Prevalent and Insidious’ Health Threat" via Paula Span of The New York Times — It happened about a year ago. I stepped off the subway and spotted an ad on the station wall for a food delivery service. It read: “When you want a whole cake to yourself because you’re turning 30, which is basically 50, which is basically dead." After a bunch of us squawked about the ad on social media, the company apologized for what it called attempted humor and what I’d call ageism.

Wednesday, April 27

11:00 AM ET — A state board known as the Three-Member Panel will meet to discuss workers’ compensation insurance issues (meeting link; call 866-899-4679 with participant code 603199453)

Thursday, April 28

9:00 AM ET — The Florida Healthy Kids Corp. Board of Directors meets at the Hyatt Regency Orlando International Airport (9300 Jeff Fuqua Blvd., Orlando)

2:00 PM ET— The national Democratic Legislative Campaign Committee hosts a news conference to support Medicaid expansion (registration)

3:00 PM ET — The Florida Children and Youth Cabinet meets in the Capitol

3:00 PM ET — Florida Trauma System Advisory Council announces a public meeting to which all persons are invited. Contact Kaylin Williams or (850) 245-4055 for a copy of the agenda (meeting link)

Friday, April 29

1:00 PM ET — The Rare Disease Advisory Council subcommittee meets. Contact Casey Omeke for a copy of the agenda (meeting link)

The Home Care Political Action Committee (PAC) is an integral part of HCAF's government affairs strategy. The PAC aims to amplify the political voice of the home care industry by pooling financial resources and supporting candidates who will represent our interests in the Florida Capitol. The PAC is a not-for-profit, non-partisan organization that is not funded by HCAF membership fees. Businesses and individuals may contribute, and there are no contribution limits.

With the Florida Legislature adjourned, the 2022 midterm election cycle is officially underway. The election for Florida's governor, lieutenant governor, attorney general, chief financial officer, agriculture commissioner, and the 160 senators and representatives will take place on November 8.

The Home Care PAC has set a fundraising goal of $50,000 for this election cycle, which will enable us to support as many pro-home care candidates as possible by Election Day. So far, we have raised more than $28,000 (56%) toward our goal.

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