August 12, 2022

Health Insurance

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Checking the pulse of Florida health care news and policy

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

Florida’s big-ticket plan to overhaul necessary Medicaid contracts is kicking into gear.

The Agency for Health Care Administration is knee-deep in negotiating and preparing to negotiate contracts that will significantly affect how the massive safety-net health care program works.

AHCA has three open invitations to negotiate with vendors interested in information technology contracts that work with Medicaid.

The state has twice extended the deadline on two invitations to negotiate (ITN) to continue negotiating beyond the termination date.

One of the extended ITNs is a $139.7 million contract for seven years to develop a unified operations center.

The state was slated to post the winning bid last week but extended the deadline by one month.

The second ITN is for a $33 million provider services module that will electronically capture, validate, and process provider enrollment applications (initial and renewal), including an automated screening and monitoring component to support state and federal requirements.

Negotiations on that ITN have also been extended by a month. The winners are slated to be announced on June 30.

A push to improve Florida’s Medicaid system kicks into gear.

Florida Politics requested the names of the vendors that submitted bids for the two ITNs. But AHCA has not yet provided Florida Politics with the information.

The state is procuring a third module for the FX Program for “core” services. The seven-year contract is worth $155 million. AHCA is slated to announce which vendor it chose for the core services module on July 8.

Meanwhile, as AHCA prepares to get busy on the procurement of the Medicaid program, it will review the responses that 54 vendors submitted to the state l by last week’s deadline on how to improve the program. Florida Politics requested the submissions, but AHCA had not provided the proposals, which are public record, by press time.

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— One more year —

Florida has until March 31, 2025, to spend the $1.2 billion the administration of Gov. Ron DeSantis requested from the federal government. Florida Medicaid officials said they would distribute the supplemental funds in two rounds.

The state planned to distribute more than $680 million in the first round of grant opportunities but initially announced that $503 million in grants would be awarded to 1,945 providers. The Agency for Health Care Administration, which houses the state’s Medicaid office, announced it would extend the opportunity for providers that didn’t submit a grant application by the initial deadline and don’t have “staff” (only contracted employees) to apply for the money.

The feds tell Ron DeSantis — use it or lose it. Image via AP.

AHCA divided the $680 million into three silos: $405 million in grants for provider stipends, $266.6 million for retaining employees and recruiting new ones, and $12 million for delayed egresses. The extended deadline came and went and repeated attempts to get information from AHCA regarding how much added grant money has been awarded and how many providers will benefit went unanswered.

Meanwhile, there’s no word from AHCA as to when it plans to make another round of grant opportunities available.

The administration of President Joe Biden gave Florida (and every other state) an additional year to spend the increased federal Medicaid funds that were made available under the American Rescue Plan.

“The Biden-Harris Administration is committed to expanding access to home- and community-based care for people with disabilities and older adults. Thanks to the American Rescue Plan, these additional funds will help people with Medicaid to live and thrive in the setting of their choice,” said Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure. “With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities.”

Home and community-based services, such as those that aid people with activities of daily living such as bathing, dressing and eating, traditionally aren’t covered by the Medicaid program. But the services could help avoid institutionalization for the elderly and those with intellectual or developmental disabilities. Florida provides home and community-based services through the Medicaid IBudget waiver and through the Medicaid managed long-term care.

— Axed —

DeSantis’ massive budget vetoes totaled more than $3 billion. While most attention was on bigger ticket items — like new state airplanes or a new prison — several health care projects also got whacked.

Senators and House members were able to sprinkle more than $337 million in health care projects in the budget sent to DeSantis.

An analysis done by Diagnosis shows that the Governor wound up vetoing nearly 70 projects totaling slightly more than $39.2 million. This total doesn’t include money in other bills and other parts of the budget, including $20 million designed to help Moffitt Cancer Center’s ambitious plan to build a new cancer center in Pasco County. The $20 million was annualized over 30 years making it a $600 million veto.

A top priority for Doug Broxson doesn’t survive the veto pen.

The largest member project vetoed in the health care budget was $4 million, which was intended to help pay for improvements to help Gulf Breeze Hospital better withstand hurricanes. The project had been championed by a pair of Pensacola Republicans: Sen. Doug Broxson and Rep. Alex Andrade.

DeSantis’s health care vetoes took out projects sponsored by legislators in both chambers and from both parties, including projects pushed by future legislative leaders such as Sen. Kathleen Passidomo, who will become the next Senate President later this year. A quick rundown shows that he vetoed projects recommended by 28 state Senators and dozens of House members.

— Spared —

While budget vetoes eliminated Moffitt funding, DeSantis let slide a hefty $125 million appropriation for the Florida State University Health Tallahassee Center. The five-story building will be located on the Tallahassee Memorial Healthcare campus and include educational, medical, and research laboratory space. The center will provide about 130,000 gross square feet.

“Combining advanced research and clinical care, FSU Health Tallahassee Center will facilitate the transformation of Tallahassee into a regional health care destination attracting patients from throughout the area and neighboring states,” said FSU President Richard McCullough. “The FSU Health Tallahassee Center provides FSU with the potential to transform health care delivery, education, and biomedical research throughout Florida, surrounding states, and the nation.”

DeSantis also let slide an $80 million appropriation for a new trauma center at UF Health Jacksonville named after Leon Haley Jr., the former CEO of the hospital killed in a Jet Ski accident last year.

The center that’s named in honor of Leon Haley Jr. has been spared the ax.

— More money —

The FY 2022-2023 budget has $126 million in recurring general revenue and more than $50 million in one-time spending for community mental health and substance use disorder services.

“This investment provides a critical boost to community providers as they treat Florida’s families who struggle with mental health and substance use disorders,” said Florida Behavioral Health Association President and CEO, Melanie Brown-Woofter. “Since entering office, Gov. DeSantis has always prioritized the mental well-being of all Floridians. The FBHA could not be more grateful to have a Governor who not only recognizes the importance of mental health and substance use disorders but also takes innovative steps forward to help community providers save lives and create stronger families and communities.”

Florida Association of Managing Entities CEO Natalie K. Kelly agreed.

“This substantial and reliable funding will go a long way toward helping Floridians access the behavioral health services they need to address mental illness and substance use disorder,” Kelly said. “Additionally, when helping Floridians get back on their feet, Managing Entities’ behavioral health providers implement wraparound services that help stabilize an individual’s entire life, including help with transportation, employment, child care, and more. Our ultimate goal is to help Floridians live life to their fullest potential, and with this tremendous financial support from the Legislature and Governor, we’re better able to help those who need it most. We’re also grateful to First Lady DeSantis for her steadfast dedication to behavioral health in Florida.”

The budget also contains a 7.8% increase in Medicaid reimbursement for nursing homes, which according to the Florida Health Care Association, amounts to an additional $293 million in funding, or about a $419,000 increase per facility.

We want to thank Gov. DeSantis and the Florida Legislature, including Senate President Wilton Simpson and House Speaker Chris Sprowls, for giving Florida the ability to grow the health care workforce, which will, in turn, support a stable and sustainable long-term care system,” said FHCA Chief Executive Officer Emmett Reed. “This budget provides our care centers the resources necessary to compete in this tight labor market and attract the workers needed to ensure Florida remains a leader in delivering high-quality care.”

Steve Bahmer, president and CEO of LeadingAge Florida, agreed with Reed ad noted that the Legislature also increased PACE expansion by $21 million, funding an additional 650 slots across Broward, Hillsborough Lake, Miami-Dade, Orange, Osceola, Pinellas, Seminole, Sumter counties as well as enhanced funding for an Alzheimer’s respite program and the Care for the Elderly program.

Steve Bahmer touts a significant increase in the 2022-2023 budget.

“We are grateful to the Governor and the Florida Legislature for their significant investments in programs that will benefit Florida’s seniors,” Bahmer said. “The budget addresses a variety of aging services, including assisted living, home and community-based services, and affordable housing for seniors, while also providing the support that is so critical for the long-term care workforce.”

— ROSTER —

Kayla McLaughlin is the new Deputy Communications Director at the Agency for Health Care Administration.

Congratulations to Kayla McLaughlin on her new AHCA gig.

Judy Frum is the new CEO of Broward Health Imperial Point. Frum had most recently served as interim CEO at the hospital. She started with the North Broward Hospital District, which operates as Broward Health, in September 2021 taking a position as chief operating officer at Broward Health. Frum also worked at Memorial Healthcare System, or the South Broward Hospital District, working as a chief operating officer and interim CEO of Memorial Regional Hospital in Hollywood, the flagship hospital for Memorial Healthcare System.

Steven Hochwald, M.D., MBA, FACS was named Director of the Mount Sinai Medical Center Broward Health, which is slated to open in 2025. Dr. Hochwald was recruited from Roswell Park Comprehensive Cancer Center in New York, an NCI-designated institution.

— ICYMI —

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

Done deal: DeSantis vetoed $3.1 billion in spending Thursday as he signed the 2023 fiscal year budget, which still leaves $109.9 billion in place, with increases in nearly every facet of the budget. The main budget bill (HB 5001) received only three “no” votes in either chamber: from Miami Democratic Reps. Mike Grieco and Dotie Joseph, and Republican Rep. Anthony Sabatini of Howey-in-the-Hills. The $109.9 billion spending plan is about $8 billion more than the current year, about a 9% increase. The whopping $3.1 billion veto list includes the $1 billion fund the Legislature set up to pay for added costs state agencies incur next year due to inflation. DeSantis also wiped away $195 million for a new prison hospital.

Ron DeSantis gives the budget a $3.1B haircut. Image via AP.

Information provided: AHCA received 54 responses to the request for information it posted in May. Insurance companies and managed care providers that responded include Aetna; AmeriHealth Caritas Florida, Inc.; Chrysalis Health; Community Care Plan; Community Health Choices; Humana Medical Plan, Inc..; MCNA Insurance Company; Molina Healthcare of Florida, Inc.; Simply Healthcare Plans, Inc and Sunshine State Health Plan. The Florida Hospice & Palliative Care, Florida Hospital, Florida Medical, Florida Pharmacy, and Florida Behavioral Health associations also submitted electronic responses to the agency’s request. So did the Florida Associations of Community Health Centers, Health Plans and Managing Entities also submitted responses.

Continuing to continue negotiations: The state has pushed back the deadlines to announce the winning submissions. The state is procuring different services as it remodels the Florida Medicaid Management Information System, known as FMMIS, from a singular system to a modular one called Florida Health Care Connections (FX) instead. The state continues to negotiate with vendors over a seven-year $33 million provider services module and a $139 million unified operations center module. The latter oversees all interactions between the agency, from receipt and delivery of all correspondence with stakeholders to distributing the Medicaid membership cards.

Transgender trifecta: Gender-affirming care was targeted by the DeSantis administration. The Governor vetoed $500,000 in funding to support an Orlando housing program for homeless LGBTQ-plus youth. Following the veto, Medicaid Director Tom Wallace, who serves as the pleasure of the AHCA Secretary Simone Marstiller (DeSantis is her boss), issued a report announcing that gender-affirming health care was experimental and that the treatments pose “irreversible consequences that exacerbate or fail to alleviate existing mental health conditions.” That same day State Surgeon General Joseph Ladapo sent a letter to members of the Florida Board of Medicine reiterating his opposition to gender-affirming care. Ladapo sent the letter in advance of the board meeting held the following day.

Not surprising: The American Civil Liberties Union of Florida filed the lawsuit in the Florida 2nd Judicial Circuit on behalf of Planned Parenthood affiliates, other women’s health centers, and other abortion-rights advocates. The law is to take effect July 1, and the groups are looking for the court to block it before it can take effect. There are no exceptions for rape or incest but do provide an exception if it is necessary to save a pregnant person’s life. “This law blatantly rejects Floridians’ need for essential abortion care and their strong support for the right to get an abortion,” ACLU of Florida Legal Director Daniel Tilley said in a news release. The law requires two physicians to certify a life-threatening emergency before accessing an abortion after 15 weeks of pregnancy. They contend that provision will disproportionately harm low-income and minority women, who may lack adequate health care access.

— FOR YOUR RADAR —

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

—”Dementia-friendly restaurants make it easier for patients and caregivers to dine out” via Joe Byrnes of WMFE — 720,000 Florida seniors will have Alzheimer’s dementia by 2025. That’s a 24% increase from 2020 to 2025. Some Central Florida restaurants are making it easier for them. It’s called dementia-friendly dining.

—”Tampa Bay hospital offers to discharge alleged malpractice victim’s bills in exchange for silence, daughter says” via Walt Buteau of WFLA — An attorney for Brandon Regional Hospital offered to discharge the medical bills of a patient who died if his daughter agreed not to talk publicly about the case that involves a doctor accused of malpractice. Keith Davis, 62, of Brandon, went to Brandon Regional in 2020 with a sore leg but died days later from what an autopsy determined was a 9-inch blood clot that Dr. Rathinam Krishnamoorthy allegedly did not detect. A Florida Department of Health investigation determined probable cause that Krishnamoorthy committed medical malpractice when he failed to treat the fatal clot.

—“Most workers who died of COVID in 2020 had something essential in common, study finds” via Daniel Chang of the Miami Herald — Most working-age Americans who died of COVID-19 during the first year of the pandemic were so-called essential workers in labor, service and retail jobs that required on-site attendance and prolonged contact with others, according to a recently published study led by a University of South Florida public health researcher. The study looks back on COVID-19 deaths in 2020 and affirms what many had already known or suspected — that Americans who could not work from home and who labored in low-paying jobs with few or no benefits, such as paid sick leave and health insurance coverage, bore the brunt of deaths during the pandemic’s first year, said Jason Salemi, an associate professor in USF’s College of Public Health and co-author of the study.

—“Is it COVID, the flu or something else? Wave of infections set up Florida for a long summer” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — The seasonal flu is spreading way past season in South Florida, sending people to clinics and hospitals with severe congestion, coughs, sore throats and body aches. “It’s madness, everyone is sick,” said Dr. Hila Beckerman, a South Florida pediatrician. Local doctors say viruses and bacterial infections on hiatus during COVID-19 are back, circulating much later than typical and setting up Florida for a long summer.

—“Records identify UCLA boss who called Joseph Ladapo unfit for Florida Surgeon General,” via Jeffrey Schweers of the Orlando Sentinel — The same UCLA supervisor who gave her “enthusiastic support” to Ladapo when he applied for a professorship at the University of Florida College of Medicine last year also refused to recommend him for Surgeon General three months later, public records show. Documents released by the Florida Department of Law Enforcement four months after a public records request disclosed that Dr. Carol Mangione was the previously unnamed supervisor interviewed by state agents as part of Ladapo’s background check for his Senate confirmation hearings.

—”Sunshine Health receives Tallahassee Community College Golden Eagle Award” — For its support of a workforce development program dubbed Gadsden Connect. Launched in January 2020, the program is a partnership between Sunshine Health and TCC that provides people in Gadsden County with an opportunity to become home health aides and certified nursing assistants. Sunshine Health has invested 85,000 in the education training program. Sixty students, ranging in age from Generation Z cohort to Baby Boomers, enrolled in the program. Roughly 82% of them, or 49 students, completed the necessary coursework. Most trained during the pandemic in 2020 and 2021. We saw an opportunity to make a difference through this partnership,” said Nathan Landsbaum, Sunshine Health CEO. “The pandemic increased demand for health care workers, especially in rural areas, so we were eager to support TCC’s efforts to combat the shortage and remove barriers that hinder people from going into this field. We’re honored to receive this award and are already working with TCC on new initiatives to help them train residents for health care careers, which increase access for residents.”

Sunshine Health wins kudos for its commitment to workforce development. Image provided.

— PENCIL IT IN —

Tuesday

Happy birthday, Sen. Jason Brodeur

Happy birthday, Jason Brodeur.

Wednesday

Happy birthday, Rep. Kevin Chambliss

9 a.m. The Florida Council on Homelessness meets. Meeting link here.

11 a.m. The Florida Rehabilitation Council meets. For more information, click here.

4 p.m. Circuit court case-management conference in the ACLU challenge of the newly signed 15-week abortion ban. The lawsuit seeks to stop the state law preventing doctors from performing abortions after 15 weeks of pregnancy. Call (470) 381-2552; 91374310997; participant code: 296497.

Thursday

11 a.m. AHCA hosts a workshop on a proposed amendment to Rule 59G59G-4.002 about the Medicaid Provider Reimbursement Fee Schedule Rule to remove ambulatory surgical center fees and outpatient laboratory fees. Meeting link here.

Friday

1 p.m. The Statewide Domestic Violence Fatality Review Team meets. More here.

1 p.m. The state Diabetes Advisory Council meets. Embassy Suites by Hilton Orlando Lake Buena Vista South, 4955 Kyngs Heath Road, Kissimmee. Call number: (850) 792-1375; participant code: 167476523.

4 p.m. The Florida Board of Osteopathic Medicine meets. Meeting link here.

Happy birthday to Rep. Jervontae Edmonds.


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