Diagnosis 5/24/23: Review of current Florida health news and policies (2023)

Welcome back to Diagnosis, a branch focused on the intersection of politics and healthcare.

- A closer look -

GovernorRon DeSantisis finally entering the presidential race after gaining a steady lead after being re-elected in November.

While DeSantis made a name for himself through his struggles with Disney and in education, he first gained national recognition during the COVID-19 pandemic. DeSantis initially defended the lockdowns, but quickly changed his stance and became a staunch opponent of most federal health guidelines.

In his quest to "make America Florida," the governor's medical records are being scrutinized more closely.

Expect political pundits to be closely watching how the DeSantis administration handles the Medicaid program's "exemption" from public health emergency rules, a requirement that the state keep people indoors during the pandemic.

The data show that in the first month of the Medicaid regulation, in April, nearly 250,000 people were disqualified, with most excluded from the program for procedural reasons. A large number of procedural withdrawals worries some. 52 organizations signed aPresentationAsk DeSantis to temporarily pause the re-identification process to ensure that people are not accidentally excluded from the Safety Net program.

Notable: The DeSantis administration claims the monthly report data is out of date and that some beneficiaries who did not respond in time sent the information to the state.

Florida is one of 10 states that has not expanded Medicaid to low-income adults without children. As a result, the state continues to have one of the highest rates of uninsured residents. In 2021, 15.1% of Florida's population under 65 was uninsured, the third highest rate behind Oklahoma and Texas.

Meanwhile, this week, DeSantis drew attention to Florida's decision to take advantage of a provision in federal law that allows states to extend Medicaid coverage for women for 10 months after giving birth, giving them a year of access on postpartum Medicaid. Notably, DeSantis did not approve of the idea. He was a former speaker of the ParliamentChris Sproleswhich urged lawmakers to embrace the idea and legislate to make it happen.

Here's a look back at his health history since his election in 2018.

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— Schedule before the pandemic —

DeSantis' first decision on health issues came shortly after taking office, when he announced that he would not oppose the use of medical marijuana.

The governor said he will not continue with the former governor.Rick Scott'small(lost) lawsuit in favor of state smoking ban. His support for medical marijuana made it difficult for DeSantis to find a Surgeon General in the state.

While DeSantis didn't appear to have a health care agenda of his own in 2019, he supported House Speakerolives joseThe ambitious agenda included eliminating Certificates of Need (CONS) for new hospitals and eventually university programs.

After years of unsuccessful efforts, the Florida Legislature passed the Telehealth Act (HB 23) in 2019, allowing out-of-state physicians to register with the Florida Board of Medicine and offer telehealth services to Florida residents. DeSantis signed the Telehealth Act into law, but unexpectedly vetoed HB 7067, which would have required the Florida Department of Health (DOH) to charge a $150 registration fee to out-of-state health professionals wishing to register as telemedicine providers in Florida.

Although originally Oliva's idea, DeSantis has become the face of the state's efforts to create a Canadian drug importation program (which has yet to receive state approval). The bill came under intense pressure, and DeSantis publicly criticized PhRMA for trying to stop it.

While DeSantis supported (and still supports) Canada's drug importation program, the governor did not support the fees associated with the legislated program. Therefore, DeSantis vetoed HB 7073, which would have allowed the state to impose an international pharmacy export permit fee of up to $250. an international prescription drug wholesaler license and an annual inspection fee of between $1,000 and $3,000.

The veto letter for 7067 and 7073 saysHere.

DeSantis continued to support Oliva's health agenda in the 2020 session, which included expanding the scope of work for some registered nurses and pharmacists in advanced practice. Although organized medicine expected the governor to veto the scope of practice laws, he did not.

The legislature did not consider issues related to COVID-19 because the session was adjourned with the onset of the pandemic.

— DeSantis and the Pandemic —

When the pandemic hit, the governor did not hesitate to use his executive powers to slow the spread—indeed, he quickly implemented many of the measures he would later view with disdain.

First came an emergency order on March 9 that declared a state of emergency. On March 20, when Florida had only a few confirmed cases, the governor issued another executive order.closeBars and restaurants. In the second mission, he emphasized the need for "social distancing" to prevent the spread of the virus.

While DeSantis is reluctant to follow federal guidance today, he has been a hardliner on measures to slow the spread — he wasfaced a processby Republican-leaning Volusia County pub owners for keeping venues closed in mid-2020.

The turning point came in September, when the state intervened."phase three” of their efforts to deal with COVID. At that point, most social distancing measures were lifted and all businesses were allowed to reopen without restrictions, although the governor allowed local governments to limit restaurant and bar capacity to 50 percent.

"You can't just say no," DeSantis said at the time. "You can't say no after six months and people just change."

As vaccines dwindled, DeSantis privately received Johnson & Johnson's one-time dose, much to the chagrin of the then Agriculture Commissioner.Nikki fritoMorewho, like other politicians, chose to be vaccinated in a public place to dispel the hesitation of vaccination. However, the governor praised the vaccination effort and urged Floridians to get vaccinated.

Contrary to his modern stance, DeSantis even downplayed concerns about the vaccine's effectiveness, arguing that vaccinated people later contracted the virus and required hospital treatment.were deviations.

"These vaccines save lives. They reduce mortality,” DeSantis said in mid-2021.

His attitude changed towards the end of the year whena special session is calledto ban regulations on masks and vaccinations and promised to challenge regulations implemented at the federal level, which he described as "one."Improper use of emergency power.»

"Your right to earn a living should not depend on vaccines for COVID," he said.

– After the pandemic –

For the past two years, DeSantis has explored health issues that could resonate with Republican voters.

In 2022, he signed legislation banning abortions after the 15th week of pregnancy, with no exceptions for rape and incest.

This law is still in effect and is currently being challenged in court. But as that legal battle continues, DeSantis signed into law a six-week abortion ban, though that version includes some exceptions as long as the person seeking the abortion has documented evidence of rape or incest.

This new ban was approved during the 2023 session. It will not go into effect until the legal dispute over the current 15-week ban is resolved.

After the former presidentDonald TrumpDe Santis hinted that a six-week suspension could be "difficult" and defended the move.

Meanwhile, according to the First LadyCasey DeSantisIn the fight against breast cancer, DeSantis prioritized increasing funding for cancer research in the state through 2022 and requested an additional $37 million in recurring funding for the National Cancer Institute's Florida Consortium Centers Program. The legislature agreed to provide the funds and later named the program (which at the time included only the University of Miami Sylvester Comprehensive Cancer Center, Moffitt Cancer Center and UF Health Cancer Center) the Casey DeSantis Cancer Research Program in honor of the First Lady change.

DeSantis also pushed for what he called the "No Patients Left Alone Act," which would have required healthcare professionals to allow visitors to eat or drink in end-of-life situations, during times of emotional distress and when patients need support relatives. or caregivers and any other circumstances deemed appropriate by the AHCA. The law requires vendors to submit their visiting policies to the AHCA for approval by January 1 of each year.

Away from the cameras and media attention, DeSantis signed legislation allowing nursing homes to reduce the number of hours of care residents must receive. AARP Florida launched a campaign to get DeSantis to veto the bill.

And with Medicaid procurement of managed care in mind in 2023, the AHCA successfully pushed for changes to the Medicaid statute intended to make the procurement process easier for the agency.

In the 2023 session, the legislature codified and expanded administrative changes DeSantis pushed through the rulemaking process the previous year, such as a ban on Medicaid reimbursement for transgender health care regardless of age and the exclusion of all transgender minors who do not in treatment. . with puberty blockers or hormones.

DeSantis also pushed for legislation during the 2023 session that would allow health care providers and insurers to deny care or reimbursement for care if doing so would conflict with their moral or ethical beliefs. LGBTQ+ and women's health advocates fear the law will give doctors and providers legal protections to discriminate against patients. Several Democratic lawmakers who opposed the bill in its final passage expressed the same concerns.

With the federal government not approving his efforts to import drugs from Canada, DeSantis has entered a long-running legislative battle over pharmaceutical benefit managers (PBMs) and their role in the health insurance system for the first time since he was elected 2018. With bipartisan support, the legislature passed what is considered one of the toughest bills in the country.

DeSantis, who opposes Medicaid expansion, doesn't seem to know much about either House Speaker.Paulo RennerKey priorities: Expanding Florida KidCare to children living in families whose income is 300% or less of the state poverty line.

It is the first time lawmakers have expanded the program since its inception. Asked at a press conference at the end of the session if he supported the project, DeSantis stepped aside to allow Renner to explain the proposal. Renner said he doesn't see the bill as a "Medicaid expansion," although it would allow families to earn more without losing eligibility for subsidized children's health coverage.

“I think it's a very strong conservative position. "Pro-family, pro-child position," Renner said.

DeSantis concluded Renner's remarks by adding, "I think he made a good point."

The governor's comments were met with loud applause from Republican lawmakers who attended the news conference.

- More transparency? —

The Centers for Medicare and Medicaid Services (CMS) announced this week that it is pursuing further changes to how the government purchases prescription drugs.

The proposed rule would allow CMS to learn more about the true costs of manufacturing and distributing the most expensive drugs on the market today in a number of ways, including developing a "drug price certification survey." The research will determine drug prices and help states better negotiate what the Medicaid program pays for expensive drugs.

Another provision of the proposed rule is intended to improve transparency about Medicaid managed care programs and the administration of drug benefits by Pharmacy Benefit Managers (PBMs).

The regulation also includes a provision requiring interstate contracts, Medicaid managed care plans and PBMs to provide transparent reporting of drug payment information.

The proposed standard also focuses on the classification of drugs as brand names or generics. The proposed rule includes provisions intended to ensure that manufacturers classify their third-party drugs as either generic or brand-name (States receive a higher rebate percentage for brand-name drugs compared to generics). When manufacturers misclassify their drugs, the proposed rule gives CMS the ability to take corrective action.

THEJoe BidenThe government announced the proposed new rule this week and will accept public comment on it until July 25. The proposed rule isHere.

- The first of its kind -

Tampa General Hospital, one of the top ten transplant centers in the country and aUS news and world reportsThe 2022-23 Best Hospitals announced this week that the academic health system completed a successful living donor liver transplant earlier this month.

"Our living donor liver transplant program is a great example of Tampa General continuing to innovate to provide world-class health care," he said.Joao Kouris, President and CEO of Tampa General. "This program provides additional access to patients in need of a liver transplant and has the potential to transform the lives of patients and their families in the Tampa Bay, Florida region and across the United States."

Tampa General's first living donor liver transplant is a major milestone not only for the health care system, but for the region. This successful business is the first of its kind on the west coast of Florida.

It is also a special story between mother and son.

Patty Sanzsuffered from liver disease for more than two years. The waiting time for a deceased donor liver transplant can be up to five years.according to the National Institutes of Health. Her sonDerekoffered to donate some of it.

"He said, 'Mom, I'm 100 percent in and you can't stop me,'" Patty Sanz said. "Now, thanks to Derek, I'm going to live my life to the fullest... It's going to be amazing."

"It's special to be able to do this for your mother," Derek Sanz said. Both TGH patients appeared healthy and in good spirits at a news conference Tuesday in Tampa, along with the surgeon who performed the recipient's surgery, Dr.Kiran Dhanireddy.

"Liver transplantation from a living donor is another way to save more lives for patients with liver disease in our community," said Dr. Dhanireddy, vice president and director of the TGH Transplant Institute and surgical director of the Comprehensive Liver Disease and Transplant Center at the TGH Transplant Institute. "The sheer generosity of living donors eliminates the need for long periods of time to access a life-saving transplant."

A whole team of medical professionals joined Dhanireddy to participate in the transplant operation, including Dr.Ashish Singhal, director of Living Donor Liver Transplantation, who performed the donor surgery. DrBasil Diego, a veteran Tampa transplant general surgeon who assisted Dhanireddy. and drVijay Subramanian, a liver transplant surgeon at Tampa General who helped Singhal.

Living donor transplantation has many advantages. More importantly, a person who decides to donate part of their liver can shorten the waiting time to receive a transplant. Also, with a living donor, there is a greater chance of a match and an operation can be planned more quickly and easily. Research has also shown that recipients of organs from living donors have better outcomes than those receiving organs from deceased donors.

Established in 1987, the Tampa General Liver Disease and Transplant Center is now one of the busiest transplant centers of its kind in the country, with a record of over 2,200 surgeries. The high number of patients reflects the rare and challenging liver diseases treated at the TGH Transplant Institute compared to other hospitals. Additionally, historically, the time required for a transplant is shorter than the national average, according to data from the Transplant Patient Registry.

For nearly 50 years, Tampa General has been the national leader in life-saving organ transplants. In 2022, the hospital performed 682 transplants, a 20% increase in the number of operations compared to the previous year. According to the United Network for Organ Sharing (UNOS), the national transplant rate increased by 3.7% in 2022 compared to 2021.

- RULES -

- The Board of Medicine is proposing to update rule 64B8-42.003 regarding dietitians and nutritionists to reflect current test scheduling practices. MoreHere.

- The Medical Board proposes to update rule 64B8-51.006 regarding the licensing and inspection of electrical installations. MoreHere.

- The Board of Nursing is proposing an amendment to rule 64B9-3.002 to clarify wording related to test results. MoreHere.

- The Board of Nursing proposes an amendment to rule 64B9-8.006 regarding disciplinary policies and penalties. MoreHere.

— LOBBYISTS —

Cynthia Henderson, Converging Public Strategies: CIOX Health, Epic Pharmacies, Florida Chiropractic Society, Moderna

Allison Liby-Schoonover, Metz Husband and Daughter: Karuna Therapeutics

Ashley Tising, Akerman: Promptcare Florida

- ETC -

— Hawthorne Ocala Operations d/b/a Hawthorne Center for Rehabilitation and Healing of Ocala has applied for a Certificate of Need (CON) to AHCA for 22 community-based nursing homes in Marion County. AHCA also received requests from Okahumpa SNF, which submitted an NOC to build a new community nursing home in Lake County with up to 150 beds, and from Sumterlake Operations, which submitted an NOC to build a new community nursing home in the county Lake District with up to 116 beds. NOCs were submitted for the May 17 NO batch cycle in Nursing Homes/Intermediate Care Facilities for the Developmentally Disabled (ICFDD).

- UF Online, the most highly regarded online baccalaureate program at the University of Florida, partners with Nicklaus Children's Health System to support registered nurses who want to earn a bachelor's degree in nursing. Opportunities begin in the fall semester of 2023. UF launched its online degree program in 2021. Called UF Online's "Gator Pathways," it is designed to invite students from all locations and walks of life to pursue your degree through of UF Online.

– Awarded US Department of Agriculture (USDA).health networka $325,224 grant to implement a WIC Community Innovation and Outreach Project (CIAO); CIAOs support efforts to develop and implement strategies to increase awareness, participation, and achievement in WIC and to reduce disparities in program delivery. The Healthcare Network program will focus on reaching WIC-eligible mothers, assisting them with the application process, and finding innovative ways to overcome barriers that prevent mothers from enrolling in WIC. The donation will fund gift vouchers, nappies and transport/taxi vouchers to motivate mothers. DOH will work with Health Network to provide an information management system to monitor program effectiveness, and DOH in Collier County will provide education and training regarding WIC eligibility and enrollment requirements..

- TO SCHEDULE -

- TGH President and CEO Couris inducted into Tampa Bay Business Hall of Fame by Tampa Bay Business Hall of FameFlorida Council on Financial Education.Since assuming leadership of Tampa General in 2017, he has championed healthcare innovation and promoted excellence in clinical care throughout the Tampa Bay region. In May 2022, Tampa General and thedocap city launched a community wellness initiative that focused on three goals: the routine prescription of exercise and healthy eating as medicine; Improvement of gym tracks and parks in the center and adjacent areas. and the development of a community garden and warehouse in East Tampa.

—Jyothi GuntaM.D., MPH, director of the Florida Department of Health in Palm Beach County, has been appointed to the Palm Health Foundation. The role of the DOH Palm Health Trustee is set to ensure that the Foundation maintains strong public health ties to Palm Beach County.

- Baptist Health Miami has hired a board-certified gynecologic surgical oncologistJean-Marie Stephan, Maryland Stephan specializes in gynecologic cancer prevention, gynecologic cancer surgery, and chemotherapy.

— ICYMI —

In case you missed it, here's a recap of other top health policy stories covered in Florida Politics this past week.

—And there: Fifty-two organizations are asking DeSantis to "pause" efforts to block the state's Medicaid long enough to review the process and make sure Florida families know they must sign up for the safety net health plan. The order comes after data showed that about 250,000 people dropped out of Medicaid in April, mostly for procedural reasons.

—Who you are: DeSantis does not support the World Health Organization's Pandemic Convention. But it is unclear whether his government's select members of the Public Health Integrity Commission feel the same way. President: Surgeon GeneralJoseph LadapoOn Monday, the group met to discuss state responses to the COVID-19 pandemic and the federal government's response.

—The waiting is the hardest part: Florida's ban on minors receiving gender-specific treatment remains in place after a federal judge postponed a hearing Friday without deciding whether to block a new state law as well as two medical board rules. US District JudgeRobert Hinklehe said he wanted to at least hear from the Attorney GeneralAshley Moody'soffice and said he wants to ensure the court and the state have access to the medical records of the three transgender children who, along with their parents, defied the new bans.

—filling in the distance: During an interview withJohn Stosel, the governor bluntly said that Social Security and Medicare are currently not designed for the long term, while also advocating for possible changes to the programs. "I think a lot of young people like me are open to it because I don't think we're going to have anything like that right now," the 44-year-old Republican said, before suggesting unspecified changes. "I wouldn't do anything for the people who are currently receiving these benefits because they were made promises and we have to keep them," DeSantis added. "Discretionary spending capital services that do things against the rights of the American people and are actually used as a weapon against factions of society that are loathed by the elite ruling class."

—Delivered signed and sealed: DeSantis signed the bill along with three others that supporters say appeals to the LGBTQ+ community Wednesday morning in a ceremony at a Tampa Christian school in front of a podium that reads "Let Kids Be Kids." SB 254 is a sweeping law that prohibits doctors from providing anyone under 18 with access to "sex reassignment prescriptions or procedures," but includes exceptions for minors born with a "clinically proven genetic disorder of sexual development." The law also limits who can provide care to only physicians and osteopathic physicians and restricts the use of telemedicine by requiring patients to certify that they are voluntarily receiving care. The certification must be in a form recognized by the government and in the same room as the doctor.

— FOR YOUR RADAR —

In addition to Florida political coverage, these stories are worth your time.

—"Here's a solution to DeSantis' Social Security and Medicare conundrum“Via Washington Post's Henry Olsen – Trump criticized DeSantis for his past calls to make major changes to Social Security and Medicare. Florida's governor and former lawmakers have tried to fend off the attacks, but there's a better way to counter Trump's claims: appeal to both conservatives and populists in the GOP by giving benefits to those in need. No wonder Social Security and Medicare are often referred to as the "third rail" of American politics. Since every American worker receives, or expects to receive, benefits from these programs, any discussion of reform raises the specter of uncomfortable change. That's why so few politicians are talking about reducing spending growth on these programs, even if current tax levels can't sustain it for long.

—"Why Is Florida Cutting Medicaid Payments?via Tampa Bay Times editorial board - In April, the Florida Department of Children and Families began deleting the state's Medicaid enrollments as part of a reduction in coverage for the COVID-19 era. Since then, the state has screened more than 461,000 people and stripped more than half of their Medicaid benefits. About 80% of the people terminated — about 205,000 — were disqualified because they did not respond to the requests required to renew their eligibility. Florida cannot turn its back on 80% of that population just because those residents have not responded. Common sense dictates that tens of thousands of them remain eligible or are eligible for coverage through other assistance programs. Someone just has to get to them first.

—"For one family, Florida abortion law caused devastating 'torture' loss"Via Ruth Marcus of the Washington Post - Baby Milo's grandfather thought he might have the hiccups. Instead, the newborn suffocated. He was born without kidneys, his lungs weren't developed properly,Milo Evan Dorbertlived a full 99 minutes. The cause of death was Potter's syndrome, discovered in the 23rd week of pregnancy. The cause of unnecessary suffering for Milo and her family was a Florida law that, according to doctors, prevented them from terminating the pregnancy even though it was clear the condition would be fatal. "For me, it's pure torture," he said.Peter Rogel, the baby's grandfather.

—"Collier officials will be able to pay health care staff in Immokalee after federal grant reimbursementvia Liz Freeman of the Naples Daily News — A group of healthcare professionals in Immokalee could find a secure job at the behest of Collier executives. That would be a reversal from mid-February, when the Collier County Commission voted unanimously to return a grant from the U.S. Centers for Disease Control and Prevention. The donation covered, among other things, the salaries of employees to conduct training on COVID-19. The council faced pressure from local residents to return the money, who claimed health workers forced the COVID-19 vaccine on migrant rural workers.

– LEAVE IT IN PENCIL –

Thursday

8 a.m- The Board of Directors of the Florida Medical Board meets. Location: Virtual meeting linkHere. Or call (571) 317-3112. Membership code 717632629.

9 a.m.– Der Prosperity & Economic Opportunity Solution Summit 2023 da Florida Chamber Foundation. Address: Hyatt Regency Jacksonville Riverfront 225 E. Litoral Dr. Jacksonville. AgendaHere.

11 hours- The Assistant Board of Physicians of Florida Board of Medicine meetsSMALL.Location: Virtual meeting linkHere. Or call (571) 317-3112. Membership code 717632629.

Freitag

2.30.- Northern Board of Medicine Probable Cause Committee meeting. Call (646) 749-3122, passcode: 841-195-637.

Montag

Happy Memorial Day

Happy Birthday Representatives.Daryl CampbellmKim Burfield.

Tuesday

Happy birthday MPKaylee Tuck.

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The diagnosis is written byChristina Jordan Sextonand edited byDrew Wilson.

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