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

HCAF distributes the Diagnosis newsletter twice per month via email to our valued members. This benefit provides the latest health policy news, views, and happenings. This newsletter is published by FloridaPolitics.com and republished with permission.

We're entering the third week of the 2022 Legislative Session, so it is a busy time in this policy sphere.

All right, there's a lot to dive into, starting with ...

A WHOLE LOT OF MONEY

President Joe Biden’s administration agreed last week to renew the COVID-19-related public health emergency through April 16. That means Florida will continue to see the enhanced 6.2% contribution for Medicaid, most likely until June 30. The Social Services Estimating Conference has not analyzed how the extension will impact the current year's budget. Based on past estimates, though, it could bring an additional $400 million in federal Medicaid funds into the state’s current year budget.

While the extension brings more money into the state’s coffers, it also means Florida Medicaid officials are precluded from removing anyone from the Medicaid rolls. In November, the latest available data, Florida had 5,035,950 Medicaid people enrolled in the program that pays the health care costs for the poor, elderly and disabled. Most of those people, 3.9 million, are enrolled in a Medicaid-managed care plan.

There are discussions about discontinuing the enrollment continuation requirement. The Center for Children and Families at Georgetown University Health Policy Institute delves into three potential scenarios states could face on that front.

That $400 million in additional Medicaid funds would be added to a roughly $600 million surplus economists announced in December. It brings the Medicaid surplus to the $1 billion mark. It was a contributing factor to the state’s $4 billion surplus economists announced Friday. House budget writers have warned that surpluses shouldn’t translate to increased spending and have started to lay the groundwork for what could be a more austere spending plan.

In what could be a harbinger of things to come, House Health Care Appropriations Subcommittee Chair Rep. Bryan Avila suggested the state may not be able to address the nursing shortage if it has to continue to spend hundreds of millions in additional Medicaid funds to enhance the Medicaid rates for the hospitals that provide the most significant amounts of Medicaid care.

WON'T CATCH THESE FOLKS SNOOZING 

Florida’s certified registered nurse anesthetists were at the Capitol again this past week as part of an ongoing effort to get legislators to pass bills that would alter the regulations in their field. The two main bills would allow nurse anesthetists to perform anesthesia in collaboration with other health care professionals instead of under their direct supervision. SB 986 and HB 437 are being sponsored by Sen. Manny Diaz, a Hialeah Republican and chair of the Senate Health Policy Committee, and Rep. Bob Rommel, a Naples Republican chair of the House Regulatory Reform subcommittee.

“During the global COVID-19 pandemic, we saw firsthand the demand and need for highly trained health care professionals, especially CRNAs who valiantly served on the front lines,” Diaz said about his legislation. “Now is the time for Florida to come in line with 43 other states that have already eliminated obstacles and unnecessary supervision requirements related to highly trained CRNAs — allowing them to practice to the full scope of their education and training.”

The Florida Association of Nurse Anesthesiology is also pushing the legislation.

“On behalf of Florida’s 5,400 nurse anesthesiology professionals, we thank Sen. Diaz and Rep. Rommel for championing these very important bills. It is time for Florida to modernize its laws as it relates to high-skilled CRNAs,” said FANA President William L. Self in a statement.

However, bills changing scope of practice can sometimes be a tough sell in the Legislature, as legislators often avoid getting into a tug-of-war between different health care professionals. Three providers are authorized to administer anesthesia in Florida: anesthesiologist assistants, certified registered nurse anesthetists, and anesthesiologists. They all have different roles and educational and training backgrounds. A separate bill has been filed that would alter regulations for anesthesiologist assistants.

THE OL' DESANTIS SIDESTEP 

Gov. Ron DeSantis, who widely promoted COVID-19 vaccines when they were first available, sidestepped a question Friday on whether he had gotten a booster shot. He called the decision to get such a shot a “private matter” and said there had been conflicting recommendations between the Centers for Disease Control and Prevention and the Federal Drug Administration over which age groups should take the booster shot. DeSantis did acknowledge that he had gotten a Johnson & Johnson vaccine back in 2021 and even told reporters in March that “we will let you know when I get the jab.” He said his decision now to remain mum was because “I’m not going to let that be a weapon for people to use.”

The Governor’s decision to keep his booster status private comes as CDC data shows Florida is below the national average. The latest numbers show 35.6% of those who have been fully vaccinated have also gotten a booster shot. Florida is ahead of many Southern states but trails Tennessee and South Carolina. Florida is one of the leaders in the South in initial vaccinations. Nearly 65% of Florida’s population is fully vaccinated and trails only Virginia, which has a rate of more than 70%. Florida ranks 22nd overall among states and the District of Columbia.

FLORIDA HEARTS OBAMACARE

Federal authorities have not released final numbers yet, but it appears Florida will once again lead the nation in the number of people getting health insurance coverage through Obamacare. The open enrollment period for those seeking coverage through Healthcare.gov ended Jan. 15. The last bit of publicly released data from Jan. 10 — based on December totals — showed that out of nearly 14 million Americans enrolled in health plans through Obamacare, almost 2.6 million were Floridians. That’s far and away the most in the nation. No. 2 Texas had 1.7 million enrolled, which represents a record number. Last year, 2.1 million Floridians signed up for coverage. Both Florida and Texas are two states that declined to expand Medicaid coverage as allowed under the Affordable Care Act.

The final enrollment numbers come after the Biden administration boosted financial support for groups encouraging people to sign up for Obamacare coverage. In August, the Centers for Medicare and Medicaid Services announced $80 million for Navigator programs nationwide after the amount had been sliced to $10 million a year by the Trump administration. Florida received $14.4 million of that total.

APPLICATIONS KEEP COMING, REJECTIONS TOO

The Agency for Healthcare Administration has received 666 applications from home- and community-based service providers who want to tap into federal dollars to fortify the home- and community-based provider network. The state reports rejecting about eight applications because of incomplete or missing information. The state, through its vendor, is reaching out to the applicants to try to fix the issues.

WORK OF ART, AND HEART

Disney cast members joined the Foundation for Hospital Art to present artwork to Capital Regional Medical Center in Tallahassee. An HCA Florida Healthcare facility, the hospital was given artwork Jan. 19. It was hand-painted by Disney staff, legislators, and visitors to the Capitol the day before. The artwork was presented to the hospital by Mickey Mouse, who partnered with Disney cast members and representatives from the Foundation for Hospital Art. “At HCA Florida Healthcare, we exist to create healthier tomorrows, and we are beyond grateful to our teams for their continued dedication to answering the call to care for our communities,” said Alan Keesee, CEO of Capital Regional Medical Center. “Health care is a work of heart, and we are extremely grateful to Walt Disney World and the Foundation for Hospital Art for this special work of art to recognize our colleagues in a magical and meaningful way.”

NEW PLAYER IN THE MARKET 

Lakeland Regional Health purchased a minority interest in BayCare HomeCare Inc. According to a news release, the deal took effect Dec. 1, and in Polk County, the entity will operate as BayCare HomeCare/Lakeland Regional Health. “We are excited to join with BayCare HomeCare in Polk County to expand and strengthen access to post-acute care within our community,” says Danielle Drummond, president and CEO of Lakeland Regional Health.

ROSTER

• President Biden set Laurence B. Alexander as chair of the International Food and Agricultural Development Board. Alexander has served for eight years as Chancellor of the University of Arkansas at Pine Bluff. Before that, Alexander worked for 22 years at the University of Florida.
• Dr. Angus Jameson was named the State Emergency Medical Services medical director at the Florida Department of Health. He succeeds Dr. Kenneth Scheppke, who is now serving as the Department’s Deputy Secretary for Health.
• Baptist Health Northeast hired Dane Bennett as its director of government relations.
• Dawn Jimenez has been named chief operating officer at LeadingAge Florida

ICYMI

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

’Must-pass’ bill — A must-pass bill for Florida’s nursing homes, doctors, and hospitals cleared the Florida Senate Wednesday by a primarily partisan 22-13 vote. Sponsored by Sen. Danny Burgess, the bill (SB 7014) extends through June 1, 2023, the protections health care providers currently have from COVID-19 related lawsuits. Other than Sen. Linda Stewart, all Senate Democrats voted against the measure. Four Senators have excused absences and did not vote. The current law that shields businesses and health care providers from COVID-19-related lawsuits was one of the first measures passed by the Legislature during the 2021 Session. The law clarifies that the plaintiff must prove gross negligence or intentional misconduct to successfully sue a health care provider for COVID-19.

Extra time — Law enforcement officers and firefighters will have additional time to file workers’ compensation claims for work-related post-traumatic stress under a bill (HB 689) that passed a House committee with no opposition. The bill, sponsored by Rep. Mike Giallombardo, builds off a 2018 law that modified the state’s workers’ compensation laws to allow first responders who have job-induced PTSD to tap into indemnity benefits which compensate injured workers for a portion of their lost wages while out of work with an injury. First responders would have 90 days after getting diagnosed with PTSD to file a notice of claim with their employer. Any claim not filed within 52 weeks of the PTSD diagnosis would be barred.

At-hotel care — Imagine receiving hospital inpatient services at home or in a hotel room. That could soon be the reality in Florida. On Wednesday, the Senate Health Policy Committee approved legislation (SB 1222) that amends existing state health care laws to allow hospitals, physicians, and emergency medical transportation providers to partner together to provide non-emergency services to patients. Mayo Clinic Jacksonville Hospital has been offering inpatient services to its patients for more than a year under a pair of waivers granted by federal and state governments. But the waivers will expire, and Sen. Aaron Bean said his bill establishes the necessary framework for facilities interested in providing inpatient care outside of a hospital setting.

Road to recovery — Republican and Democratic Senators said they are all behind an effort by Sen. Rouson to make it easier for former addicts to serve as counselors for those dealing with substance abuse problems. Rouson is sponsoring a bill designed to boost the number of “peer specialists” who can help those treated for drug and alcohol addiction and those struggling with mental illness. SB 282 cleared its second Senate committee Wednesday and has only one more stop before it reaches the full Senate. Rouson is a recovering addict and has pushed similar legislation in years past. That includes the 2021 Legislative Session when a similar bill sailed through the chamber, passing unanimously.

Wrecking ball? — At the start of only the second week of this year’s Session, several Senators were absent, prompting the cancellation of at least one committee meeting Tuesday. The absences of Sens. Darryl Rouson, Jason Brodeur, Ileana Garcia, and George Gainer are excused, a Senate spokesperson said, but there is speculation that some Senators may be missing because of COVID-19 infections. Gainer’s request to be excused was not COVID-19 related, Senate spokesperson Katherine Betta said. She didn’t comment on the other Senators’ requests to be excused. Rouson told Florida Politics Tuesday morning that he tested positive for COVID-19 on Friday. Garcia gave a television interview with CBS Miami’s Jim DeFede, where she refused to say whether she was vaccinated. Brodeur did not immediately respond to Florida Politics.

RADAR

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

“Lakeland Regional and BayCare aim to improve access to home care in Polk County” via Paul Nutcher of The Lakeland Ledger — Lakeland Regional Health has purchased a minority interest in BayCare HomeCare. In Polk County, BayCare HomeCare services will be known as BayCare HomeCare/Lakeland Regional Health. A news release issued Wednesday said the region’s health care providers engaged in the transaction to “improve access to high-quality post-acute care for Polk County patients.” The transaction took effect on Dec. 1. Angel Eyes Home Care owner Alicia Claircius, who has a doctoral degree in nursing practice has worked for both health care providers as a supervisor, said hospitals have had difficulty finding home health care workers because they were afraid to work because of COVID-19 and changed jobs. “I think it will be a great partnership because BayCare already has an established home health care service,” she said.

Medicaid-managed care bill sets up contract battle — A newly filed Senate bill seeks to rework the state’s Medicaid-managed care program as the multibillion-dollar contract renewal process heats up, Arek Sarkissian of POLITICO Florida reports. Sen. Jason Brodeur, who is sponsoring SB 1950, said the bill would better incentivize keeping managed care enrollees healthy, which would result in reduced costs for the state and medical providers alike. He said it could also include dental care plans under separate regulations. “We will let the process work and see what conversations evolve,” he said. The bill is scheduled to go before the Senate Health Policy Committee when it meets on Jan. 26 at 10 a.m.

“Health care industry faces clashing vaccine policies, will follow federal law over state ban” via Liz Freeman of Naples Daily News — Florida hospitals and nursing homes will comply with a federal mandate to vaccinate employees, but it will drive up already staggering staff shortages and further reduce patients’ access to essential care, industry officials say. Hospitals, nursing homes, and other health care industries that receive Medicare and Medicaid funding in the state are in a bind if they abide by the federal mandate. Under the federal mandate, they risk sanctions by losing the government reimbursement, but a state law passed last fall outlaws vaccine mandates among businesses. The state can impose fines on businesses, but at least one hospital system in Southwest Florida, the NCH Healthcare System in Collier County, has not received any notice from the state about violating the state ban despite appearing on a list of violators in October.

“Study finds employees in Florida pay among the highest rates for health insurance” via Katrine Bruner of WFIT — A new study from The Commonwealth Fund found that the average amount that Florida workers paid for premiums — which come out of their paychecks — and deductibles were $9,284 in 2020, or 16% of the state’s median income. Ten years ago, Florida’s workers paid $5,205 — or 11% of the state’s median income. Overall, the cost of health insurance in Florida is comparable to the rest of the country. But employees here have to shoulder a more significant burden. “Workers in Florida pay a greater percentage of that premium — one of the highest in the country,” said Sara Collins, the study’s lead author. “And then median income in Florida is lower than the national average, actually significantly lower. So, it's really a perfect storm for high-cost burdens.”

“Monopoly lawsuit alleges HCA intentionally diverted patients from partner ASCs to its own hospitals” via Dave Muoio of Fierce Healthcare — A new lawsuit against HCA Healthcare accuses the health system of monopolizing the orthopedic surgery market in Sarasota and harming its surgical partners with sham contracts that direct patients to the chain’s nearby hospitals. The case was filed in a Tampa federal court Wednesday on behalf of the doctors of Kennedy White Orthopedic Center, an orthopedic surgical practice that operates out of an ambulatory surgery center (ASC). The plaintiffs and HCA have a partnership agreement to own and operate that ASC. The lawsuit alleges that HCA has used its majority ownership of that partnership to appoint itself as the general partner and manager of the ASC “with complete control over all decisions involving the partnership and surgery center.”

PENCIL IT IN

The following health care events take place this week. Legislative committee meetings can be viewed live on TheFloridaChannel.org or accessed after the meeting takes place. Find legislation online at FLSenate.gov or MyFloridaHouse.gov. All times are Eastern Standard Time.

Monday

10 a.m. — The House Democratic Caucus on the issues of the day. Leader Evan Jenne, Leader-Designate Rep. Ramon Alexander, and Policy Chair Representative Fentrice Driskell hold weekly media availabilities on The Florida Channel, and they are available in their archives afterward. The media can participate using this link.

10:30 a.m. — The Statewide Human Trafficking Council meets. Place: Department of Children and Families, 2415 N. Monroe St., Tallahassee.

10:30 a.m. — U.S. Debbie Wasserman Schultz joins Sen. Lauren Book and Reps. Robin Bartleman, Rep. Christine Hunschofsky, and Felicia Robinson to discuss the 49th anniversary of Roe v. Wade and attacks on reproductive rights. Place: Zoom link here.

3:30 p.m. — The House Health & Human Services Committee meets and will consider HB 17 regarding telehealth; HB 413, the delegation of the administration of prescription medicine; HB 459, regarding step therapy; HB 791, regarding organ harvesting practices of the People's Republic of China; and HB 855, managed care.

Tuesday

Happy birthday, Sen. Aaron Bean.

9 a.m. — The House Professions & Public Health Subcommittee meets. Place: 212 Knott Office Building.

10 a.m. — STEM Day at the Capitol.

10 a.m. — The Senate Children, Families, and Elder Affairs Committee meets and will consider SB 1120, a child welfare bill; SB 1262, regarding mental health and substance abuse; SB 1358 establishing the Task Force on the Monitoring of Children in Out-of-Home Care; SB 1452, funding for Sheriffs Providing Child Protective Investigative services; SB 1550, regarding minors’ autopsy reports and public records; SB 1560, voluntary admissions for mental illness; SB 1598, Domestic Violence Task Force; and SB 1710, regarding guardianship.

1 p.m. — The Senate Ethics and Elections Committee will consider a slate of gubernatorial appointees, including Department of Veterans' Affairs Executive Director James S. Hartsell. Place: 110 Senate Office Building.

1 p.m. — The Senate Military and Veterans Affairs, Space, and Domestic Security Committee meets and will consider SB 1028 regarding end-stage renal disease, and SB 1712, establishing a Veteran Suicide Prevention Training Pilot Program. Place: 37 Senate Office Building.

3:30 p.m. — The House Children, Families & Seniors Subcommittee meets. Place: 102 House Office Building.

3:30 p.m. — The Senate Banking and Insurance Committee meets and will consider SB 926, which revises licensure examination requirements for dentists to require applicants to demonstrate specific clinical skills on a manikin rather than a live patient. The bill also repeals the requirement that any person applying to take the practical dentistry or dental hygiene exam in Florida maintain medical malpractice insurance in amounts sufficient to cover any incident of harm to a patient during the examination.

Wednesday

8 a.m. — Walmart Wellness Day at the Capitol. Location: Second Floor Rotunda

10 a.m. — The Senate Health Policy Committee meets and will consider the nomination of Joe Ladapo as the state Surgeon General and Florida Department of Health Secretary. Location: 412 Knott Office Building.

1 p.m. — The Senate Appropriations Subcommittee on Health and Human Services meets and will hold a panel discussion on the nursing shortage. Agenda here. Place: 412 Knott Office Building.

Thursday

8 a.m. — The Board of Medicine Probation Committee meets. Agenda here. Meeting link here.

11 a.m. — The Board of Medicine Council on Physician Assistants meets. Meeting link here.

11:30 a.m. — The Finance & Facilities Subcommittee meets. Location: 17 House Office Building.

11:30 a.m. — The Senate Appropriations Committee meets. Location: 412 Knott Office Building.

1 p.m. — The Boards of Medicine and Osteopathic Medicine Surgical Care/Quality Assurance Committee meet. Agenda here. Meeting link here.

2 p.m. — The state Agency for Health Care Administration holds a meeting on a proposed rule for birth center licensure, 59A-11.003, and a proposed rule for required reports birth centers must submit to the state, 59A-11.019. Call (888) 585-9008; participant code: 476211242.

2:30 p.m. — Senate Session. Location: Senate chambers, Fourth Floor Capitol.

4 p.m. — The House Health Care Appropriations Subcommittee meets. Location: 17 House Office Building.

Friday

10 a.m. — Senate Session. Place: Senate chambers, Fourth Floor Capitol.