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.

All signs point to an on-time departure for the Florida Legislature this coming Friday as House and Senate budget negotiators worked over the weekend to put the finishing touches on a new spending plan. Yes, Lawmakers could be coming back soon in a special session to deal with congressional redistricting, but the door is closing for Legislators eager to enact health care policy for 2022.

This past week a sharply-divided Legislature sent Governor Ron DeSantis a bill that would ban all abortions after 15 weeks — and he is expected to sign it.

And then there’s the Governor's push for a bill that would prohibit medical boards from going after doctors for opinions they express, including through social media. DeSantis on Thursday reiterated his support for the bill, which has stalled in both chambers.

However, an ever-important rule for the final days is that nothing is truly dead until Sine Die is declared, and the white handkerchiefs are dropped in the middle of the fourth-floor rotunda in the Capitol.

While the window of opportunity is closing, several other substantive health care issues remain in play. Let's take a look at them.

That's a Lot of Cash

Will a top priority of Senate President Wilton Simpson — a plan to help Moffitt Cancer Center with a significant expansion in Simpson’s home county — make it across the finish line?

Moffitt — a well-known cancer treatment and research center named after former House Speaker H. Lee Moffitt — has been pushing ahead on its plans to move into Pasco County for several years now. The organization acquired land in 2020, and then a year ago, the Pasco County Commission approved $25 million to support road connections and infrastructure.

Moffitt serves more than 68,000 patients a year — but officials say they anticipate having more than 100,000 patients by 2026. They say their current hospital is at or near capacity and that the space crunch could hamper recruitment efforts.

The organization wants to create what it calls a “global destination to live, work and cure center” in Pasco. They project that eventually, there will be 16 million square feet for everything from research labs to light industrial and manufacturing to clinics.

The Senate has proposed helping Moffitt with a recurring $20 million a year budget item that would last for the next 30 years and ultimately cost $600 million. The first year’s funding is included in the proposed Senate budget, while a budget conforming bill (SB 2526) includes language pledging the money until 2052. None of this has been backed by House Republicans so far.

The expansion site is about 40 miles from Simpson’s home, and he said the money would help fast track the expansion.

“This facility will rival any cancer research center in the whole planet when Moffitt is finished with it,” Simpson told reporters on Thursday. “And so, when you think about the lives that will be saved 10 years from now, tens of thousands probably annually because of the research that would be done at Moffitt.”

Other appropriations are tied to roads and schools linked to the project, which connects to a large mixed-use master-planned community that will feature wellness trails and yoga.

Medicaid Managed Care

Florida’s existing Medicaid managed care contracts expire on December 31, 2024, which means that the Agency for Health Care Administration (AHCA) will soon begin working on a new Medicaid procurement. Before that occurs, though, the DeSantis administration would like to update the law. Some of the changes the Governor's office would like to see include eliminating a requirement the state issue separate bids for each Medicaid region.

The Senate passed its version of the managed care bill SB 1950, and, according to top Republicans in the chamber, they aren't in the mood to negotiate. The House's version of the bill, HB 7047, is on the House’s Special Order Calendar for Monday. And while there aren't many differences between the chambers' bills, the differences are significant. A deal-breaker for the Senate is the House's push to include language in the bill that requires “essential providers” to sign contracts with Medicaid managed care plans on a regional or statewide basis, a move opposed by the Safety Net Hospital Alliance of Florida.

Nursing Home Staffing

Florida nursing homes appear poised to have a pretty good session. Nursing homes already have been given extended COVID-19 liability protections, and the chambers are debating just how much additional revenue to provide the long-term care facilities that treat the state’s most vulnerable residents.

The Florida Senate could pass another nursing home priority, paring back the amount of "nursing" care they must provide as early as Monday.

Sponsored by Representative Lauren Melo, HB 1239 requires facilities to conduct assessments to determine the staff needed to provide the type of care required for the facility’s resident population by considering the types of diseases, conditions, physical and cognitive disabilities, as required by federal rule.

The level of resident care required would be determined by the facility assessment and the resident’s direct care plan. At a minimum, the bill would maintain a minimum of two hours of staffing by certified nursing assistants (CNAs), a reduction from the current 2.5-hour requirement. Two statewide nursing home associations and the Florida Justice Association, which represents trial attorneys, are supporting the bill. But the bill is opposed by AARP Florida, which will call on DeSantis to veto the bill, according to AARP Associate State Director of Advocacy Zayne Smith.

The nursing home associations say the bill is a "modernization" of statutes and is necessary due to a staffing shortfall. But the industry has tried to eliminate the staffing mandate for more than a decade.

However, Senator Ben Albritton, the Senate sponsor, has already promised that this will not be the end of legislation that tackles the state’s nursing home industry. He promised this past week that there needed to be a “better way” to create a staffing model and that he would return in 2023 with additional changes.

Roster

Quantum Foundation has recently appointed Shaun McGruder to its board of directors. McGruder is currently the partner and co-founder of Palm Beach Capital, a leading private equity group focused on the capital needs of private, growth-oriented companies in the U.S. lower middle market. Quantum Foundation is a health foundation formed from $135 million in proceeds from the sale of JFK Medical Center.

Anatoly Nikolaev, M.D., Ph.D., has joined Cleveland Clinic Weston’s Maroone Cancer Center. Dr. Nikolaev is board-certified in radiation oncology and specializes in head and neck cancer, and central nervous system disease sites.

ICYMI

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

Casey DeSantis Cancer Research — House and Senate health care budget negotiators agreed to increase by $37 million the amount of money the state spends on cancer research, giving the Governor a budget victory. The Senate has insisted that the funding stream be named after Florida First Lady Casey DeSantis, who was diagnosed with breast cancer last year. The Governor announced last week that the First Lady who has been undergoing treatment is cancer-free.

Done Deal — Certain Medicaid enrollees with schizophrenia can bypass step therapy requirements under a bill that cleared the Legislature last week. If medications were dispensed within the previous year, under SB 534, enrollees wouldn't be required to undergo step therapy requirements for schizophrenia drugs.

Managed Care Under Microscope? — The Agency for Health Care Administration could be required to review the numbers of Medicaid enrollees diagnosed with sickle cell disease and how contracted managed care plans provide care for them. The analysis was part of a Medicaid budget offer that at press time still had not been agreed to by the Senate.

Kratom Regulation is Kaput — A bill that would have banned the sale of kratom to people under 21 and required processors to ensure the products contain no dangerous substances. Sarasota Republican Senator Joe Gruters filed the measure (SB 1076), dubbed the “Kratom Consumer Protection Act,” in late November. It received unanimous support in two committees before hitting a snag in the Senate Appropriations Committee.

Not Going to Happen — Bills that would have required school districts to make menstrual hygiene products available at no charge in each school nurse’s office or another physical school facility for health services are dead. Senate Democratic Leader Lauren Book filed the Senate version of the bill (SB 248) in September. Miami Beach Democratic Representative Michael Grieco filed a House companion (HB 175) later in the month. This is the second time in as many years the bills have been filed in the Florida Legislature but not heard.

For Your Radar

In addition to the coverage on Florida Politics, these stories are worthy of your time.

"Florida Among States Launching Probe Into TikTok’s Effect on Kids’ Health" via CBS Miami — A nationwide group of state Attorneys General have launched an investigation into TikTok and its possible harmful impact on the mental health of young users, widening government scrutiny of the wildly popular video platform. The probe zeros in on the social media platform’s engagement techniques to determine whether any of its practices may run afoul of state consumer protection laws, according to announcements by the states.

"‘I Almost Lost My Baby': Parents Demand Answers From FDA" via Helena Bottemiller Evich of POLITICO — Two weeks after a nationwide recall of infant formula tied to five hospitalizations and two deaths, the Food and Drug Administration is refusing to answer questions about why it took months to take action, while parents, lawmakers, and advocates ratchet up pressure on the agency.

"COVID-19 Pill Prescriber Rules Limit Reach of ‘Test to Treat’ Plan" via Celine Castronuovo of Bloomberg Law — President Joe Biden’s “Test to Treat” initiative, unveiled this week in his State of the Union address, would establish hundreds of locations where patients can immediately receive an authorized antiviral pill from Pfizer Inc. or Merck & Co. if they test positive for the virus. The medications are only available by prescription, so the test-to-treat centers will be at local pharmacy-based clinics, community health centers, and other facilities that have in-house physicians or other authorized prescribers. Pharmacy groups say the restriction could harm minority and rural communities, typically less likely to have primary care providers and rely on independent pharmacists as their main source of care.

"Senate Votes to End COVID-19 Emergency Declaration, Joe Biden Threatens Veto" via Alice Miranda Ollstein of POLITICO — While the legislation has a slim chance of passing the Democrat-controlled House and Biden has already threatened to veto the bill, the vote is yet another rebuke of the administration’s pandemic policies at a time it is seeking billions from Congress to keep them going for several more months. Republicans brought the bill to the floor using a technical process under the National Emergencies Act, which allows for a simple majority floor vote if the committee of jurisdiction fails to take up the bill within two weeks.

"As Omicron Diminishes, COVID-19 Hospitalizations Still Twice as High as Before the Variant Arrived in Florida" via Cindy Krischer Goodman of the South Florida Sun-Sentinel — The omicron wave is diminishing in South Florida, but the variant’s impact is still being felt. New cases and positivity continue to fall, yet COVID-19 hospitalizations and deaths are not at the low levels they were before the wave. This week, new cases and the state’s positivity rate fell to levels they have not been at since early December, with 14,148 new cases and a positivity rate of 3.3%. The two measures are now close to Florida's numbers in June 2021, before the delta surge. However, COVID-19 hospitalizations are still twice as high as at the end of November before the omicron wave began.

"California Could OK Abortions by Solo Nurse Practitioners" via Adam Beam of The Associated Press — A bill announced Thursday in the California Legislature would let some nurse practitioners perform abortions without the supervision of a doctor — part of a plan to prepare for a potential influx of patients from other states if the U.S. Supreme Court allows states to ban or severely restrict the procedure.

ETC.

HCA Florida Healthcare has launched a statewide campaign, including a new website, touting the company's vast infrastructure in the state, including 11,000 physicians, 77,000 colleagues, 49 hospitals, and more than 350 physician practices, free-standing emergency rooms, and other sites of care in Florida. The company has been rebranding its facilities for the last three months. On March 3, all facilities will have the HCA Florida Healthcare moniker.

The United Health Foundation is making a $1 million donation to support relief efforts in Ukraine. The donation includes $500,000 to Save the Children, the U.S. affiliate of Save the Children International, and $500,000 to Direct Relief, a long-standing United Health Foundation partner on disaster response.

The Florida Department of Health in Marion County issued a health alert for harmful blue-green algal toxins in Orange Lake, near McIntosh. It's in response to a water sample taken on March 1 by the Florida Department of Environmental Protection. The public should exercise caution in and around Orange Lake.

Pencil it in

The following events take place this week. Legislative meetings can be streamed live or viewed after the meeting takes place on The Florida Channel. To view legislation being considered, visit FLSenate.gov or MyFloridaHouse.gov. All times listed are Eastern Standard Time.

• It's Glaucoma Awareness Week

Monday, March 7

• Day 55 of Session Rule: 12.2(b) (1&2)
• House Rule Main floor amendments must be approved for filing with the Clerk not later than two hours before Session is scheduled to convene on the day a bill appears on the Special Order Calendar; and amendments to main floor amendments and substitute amendments for main floor amendments must be approved for filing not later than one hour after the main floor amendment deadline.
• House Rule 10.11(a)(3) After the 55th day (March 6) of a Regular Session, the Special Order Calendar shall be published in one Calendar of the House and may be taken up on the day the Calendar is published.
• House Rule 10.18 After the 55th day (March 6) of a Regular Session, no House bills on second reading may be taken up and considered by the House.
• 10:00 AM – The Senate is in session.
• 10:30 AM – The House is in session.
• 6:00 PM – House Rules Committee meets.
• 6:15 PM – Senate Special Order Calendar group meets.

Tuesday, March 8

• 10:00 AM – The Senate is in session.
• 10:30 AM – The House is in session.
• 6:15 PM – Senate Special Order Calendar group.

Wednesday, March 9

• Seersucker Day at the Capitol.
• 10:00 AM – The Senate is in session.
• 10:30 AM – The House is in session.
• 6:15 PM – Senate Special Order Calendar group meets.

Thursday, March 10

• Day 58 of Session Rule 10.19 After the 58th day (March 9) of a regular session, the House may consider only: Returning Messages, Conference Reports, and Concurrent Resolutions.
• 10:00 AM – The Senate is in session.
• 10:30 AM – The House is in session.
• 6:15 PM – Senate Special Order Calendar group meets.
• 7:00 PM – 2022 Black & Caribbean Caucus Legislative Sine Die Celebration.

Friday, March 11

• 10:00 AM – The Senate is in session.
• 10:30 AM – The House is in session.