Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Despite ongoing pressure from some members of Congress, the public health emergency declared at the onset of the COVID-19 pandemic is expected to stay in place for the first quarter of 2023.
This declaration — and when it may end — is significant because of its impact on Florida’s mammoth Medicaid program.
The Biden administration promised to give states 60-day notice if the administration plans to lift the designation, which must be renewed every 90 days. The current declaration is due to expire Jan. 11, meaning the notification deadline was Nov. 11.
The Senate this week voted 62-36 in favor of a resolution that would end the overall national emergency declared due to COVID-19. Both Florida Senators — Rick Scott and Marco Rubio — voted to end the emergency, but the Biden administration has vowed to veto the legislation should it reach his desk.
In a statement, the administration said that “while COVID-19 is no longer the disruptive threat that it once was, and we have made tremendous progress in combating the virus, the virus continues to pose a risk to the American people and our health care system.”
The continuation of a public health emergency related to COVID-19 will affect overall state spending on Medicaid since Florida is receiving a higher share of federal reimbursement right now. But that comes with a requirement that people be allowed to remain enrolled in Medicaid. Medicaid enrollment is expected to peak at 5.35 million people during the current fiscal year.
State economists had forecast last August that the overall enrollment would begin to drop once the public health emergency is dropped and the state can start to remove people from the rolls.
Because of the uncertainty, the National Association of Medicaid Directors sent a letter Thursday asking that Congress step in and provide clear direction on the “unwinding” of the public health emergency. The group asked for at least a 120-day notice before states should start redetermining if someone is eligible for Medicaid and provide a phased-out approach to when the extra federal aid now flowing into the state will stop.
“With the lack of an announcement from the U.S. Department of Human Services that the national COVID-19 Public Health Emergency (PHE) will end in January 2023, states are now assuming the PHE will extend into April 2023,” the letter read. “This extension of the PHE — which would be the 12th such extension — exacerbates the uncertainties for state planning to resume normal Medicaid operations. This, in turn, increases the risk of unnecessary losses of health insurance coverage for Medicaid members.”
The letter added the uncertainty around the fate of the public health emergency is “untenable.”
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— Time passages —
Florida’s Medicaid managed care program is the most expensive procurement in the state, and all eyes are on the upcoming bid.
The multiyear contracts are worth billions of dollars to the winning Medicaid managed care plans, and health plans that aren’t chosen to participate in the program will be shut out of Florida’s Medicaid market for six years unless they merge with or buy a managed care plan that did submit a winning bid.
The Agency for Health Care Administration (AHCA) repeatedly has said it expects the procurement to begin sometime during the fourth quarter of the calendar year 2022.
AHCA can still make its self-imposed timetable if it marks the beginning of the procurement cycle with the publication of what’s known as the Medicaid Data Book.
The data book is the Holy Grail of re-procurement. It holds all the information about the state’s Medicaid program that a managed care plan wants or needs to know about the safety net program that serves the poor, elderly and disabled before deciding whether it wants to compete for a contract.
The information book must be published at least 90 days before AHCA publishes its Invitation to Negotiate (ITN).
To date, AHCA has not published the Medicaid Data Book (though the Governor’s office allegedly has the information and is reviewing it.)
Even if the book were to be published tomorrow, the agency wouldn’t be able to post its ITN until the beginning of February.
— Far out —
Can a drug compound made from tomatoes restore age-related muscle loss?
Siobhan Malany, Ph.D., an associate professor of pharmacodynamics at the University of Florida College of Pharmacy, can’t wait to find out.
The Falcon 9 rocket is slated to launch from the Kennedy Space Center in Cape Canaveral next week. On the rocket will be a tiny laboratory that Malany and other UF scientists have built that plugs into the Space Station. The experiment will allow scientists to understand how microgravity affects human muscle biology.
The findings could lead to new therapies for age-related muscle loss on Earth.
“Scientists have turned to space to study the effects of aging because microgravity can accelerate muscle mass changes,” Matany said. “If we can take what we learn in space and apply it to drug development on Earth, then we’re taking a big step forward in developing new therapies for muscle loss in older adults.”
Muscle loss in older adults leads to a decline in mobility, which leads to scores of other problems including falls and fractures.
The UF-built lab features an automated tissue chip system, which feeds nutrients to 3D muscle bundles every six hours. The chips have electrodes that will allow scientists to study muscle contractions. The laboratory also has a microscope camera system that will capture images.
While other chip-based experiments performed on the International Space Station can take weeks of crew time, the UF experiment is fully automated and doesn’t require work from the Space Station crew.
Moreover, the experiment also tests advances in the automation of human tissue-chip technology via miniaturized labs. According to UF, the long-term goal is to, among other things, replace the use of animal models.
The National Institutes of Health and the National Center for Advancing Translational Sciences funded the research. It is also supported by AdventHealth Orlando, Micro-gRx Inc., Micro Aerospace Solutions Inc., Space Tango and the UF Department of Biomedical Engineering.
— Apprentice opportunities —
The Florida Behavioral Health Association (FBHA) developed the first behavioral health apprenticeship model in Florida after receiving a grant from the Florida Department of Education last year.
Dubbed Health Quest, FBHA President and CEO Melanie Brown-Woofter said the program’s goal is to bolster employment in the behavioral health field by supporting recruitment and retention efforts and encouraging more individuals to consider entering the field.
People are given three apprenticeship tracts to choose from: addictions counselor, behavioral health technician and peer specialist.
Since it’s National Apprenticeship Week, there’s no time like the present to tout its success.
According to the FBHA, nearly one dozen professionals have enrolled in the program since its launch. Forty-seven-year-old Charli Cole, a special projects director at STEPS in Orlando, was one of those enrollees.
She said the opportunity was a life changer.
“The apprentice program gave me the opportunity for on-the-job training and experience to help me advance my education and job skills while maintaining my employment. Thanks to full support from my employer, pursuing the certification for the Addictions Counselor gave me more confidence,” Cole said in a prepared release. “It also encouraged me to go back to school and further my education, knowing that I had such a supportive work environment.”
— Drive safely —
Forty-five people died and another 255 were seriously injured last year after 4,585 automobile accidents occurred over five days last year around Thanksgiving on Florida’s highways and byways.
To ensure the safety of all road users this holiday season, the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) and its division of the Florida Highway Patrol (FHP) launched the Safe Holiday Travel campaign. The multi-phased safety messaging will be staggered throughout November and December, focusing on road-ready vehicles, specifically road-ready tires.
According to the agency, bad tires caused more than half the accidents (2,811) occurring over the five days last year. Thirty-two people died in those accidents, and another 76 were seriously injured.
“Florida continues to be a top holiday destination for visitors and residents, making our roads some of the busiest during the upcoming months,” said FLHSMV Executive Director Terry Rhodes. “As you prepare to hit the road this Thanksgiving, or at any point this holiday season, make sure you and your vehicle are ready for the trip, always buckle up, and remember that safety is always in season.”
— RULES —
— The Board of Medicine proposes Rule 64B8-9.019 about the practice standards for treating gender dysphoria in minors. More here.
— The Board of Osteopathic Medicine proposes Rule 64B15-14.014 about the practice standards for treating gender dysphoria in minors. More here.
— The Board of Hearing Aid Specialists proposes amending Rule 64B6-6.005 about the qualifications for independent testing agents. More here.
— The Board of Hearing Aid Specialists proposes amending Rule 64B6-6.008 about advertising and business location requirements. More here.
— The Board of Occupational Therapy proposes amending Rule 64B11-4.001. More here.
— The Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling proposes amending Rule 64B4-3.001 to update rule language and incorporate an application form. More here.
— The Department of Health (DOH) proposes developing rules for genetic counseling, including Rule 64B4-1.001, which includes a licensure application form and Rule 64B4-1.002, which addresses continuing education requirements. More here.
— The DOH Division of Disease Control proposes amending Rule 64D-3.042 regarding sexually transmitted diseases and pregnancy and delivery. More here.
— LOBBYING —
—Ronald L. Book and Kelly C. Mallette have registered to lobby for Bright Health Group.
—Foyt Tipton Ralston has registered to lobby for Dialysis Clinic, Inc.
—Sharon C. Smoley has registered to lobby for Embrace Families, Inc.
— ROSTER —
— Tracy Cantella has been named Secretary of the Senate. Cantella has worked for the Senate for more than 20 years, starting her career in the Senate Secretary’s Office. For the last decade, she has served as professional staff to the Senate Committee on Rules, training under John Phelps, the former clerk for the House of Representatives and the Rules Committee Staff Director.
— Centene Corporation has appointed Monte Ford to its Board of Directors. Ford is a leading technologist who has worked for Fortune 500 companies across various industries. He currently sits on the boards of JetBlue Airways, Iron Mountain and Akamai Technologies, and recently served on the Health Care Service Corporation (HCSC) board.
— Ivan Matos Diaz, M.D., has joined Miami Neuroscience Institute, a part of Baptist Health, as co-director of cerebrovascular neurology. Before joining Miami Neuroscience Institute, Matos was with Hennepin Healthcare, where he served as a neurohospitalist, as well as medical director for the Hennepin Healthcare Comprehensive Stroke Center.
—Ed Daech has been named chief human resources officer at UF Health Shands. He starts Jan. 2.
— ETC —
— American Medical Association (AMA) President and California physician Jack Resneck Jr. delivered a fiery speech this week at an interim meeting of the AMA House of Delegates in Honolulu. His message: “When politicians insert themselves in our exam rooms to interfere with the patient-physician relationship … when they politicize deeply personal health decisions or criminalize evidence-based care … we will not back down. We will always stand up for our policies … for physicians … and for our patients.” Watch Resneck’s speech here.
— There are now two doctors in the Florida House of Representatives. Joel Rudman, M.D., was elected to House District 3. He joins Rep. Ralph Massullo, M.D., who won re-election in House District 23.
— The University of North Florida Brooks College of Health has been named one of the top 50 schools for online health care administration education by EduMed.org. EduMed.org reviewed more than 7,700 accredited schools and ranked qualifying schools for each health care discipline based on academic counseling services, career placement services, student-to-faculty ratio, tuition, percentage of students receiving school-based financial aid and amount of school-based aid per student. UNF’s online health care administration program earned top honors for overall quality, affordability and commitment to student success.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— No surprises: Gov. Ron DeSantis will keep Surgeon General Joseph Ladapo around for a second term. Ladapo, who had been on the faculty of the University of California at Los Angeles, has been a key partner with DeSantis since coming on board more than a year ago. He has been skeptical of COVID-19 vaccines and recently led the charge to convince state medical regulators to draft new rules that prevent doctors from prescribing gender-affirming care for minors. In a tweet Monday, DeSantis said Ladapo “has done a great job” in his role as Surgeon General and Secretary of the Department of Health.
— Roll with the changes: As Florida’s medical marijuana market grows and flourishes, the DeSantis administration has changed leadership in the Office of Medical Marijuana Use (OMMU). Christopher Phillip Kimball was named the director of the OMMU Nov. 11, Department of Health (DOH) Deputy Chief of Staff Weesam Khoury told Florida Politics Wednesday afternoon. Kimball replaces Chris Ferguson, a longtime department employee who headed the office for the last three years.
— Legalize it: A record-high 68% of Americans support cannabis legalization, an October Gallup Poll finds, up from just 12% support in 1969 when Gallup first asked about legalization and up from polls taken since 2016 when support averaged at least six in 10. Conservatives, religious Americans and older individuals are the least likely to support cannabis legalization.
— Another review: The Florida Supreme Court has been asked to weigh in on a high-profile medical malpractice issue: Are adverse medical incident reports subject to disclosure under so-called Amendment 7 to the state’s constitution or are they protected from discovery under a 2005 federal law? The Florida Supreme Court already addressed the issue in 2017, but the 1DCA is asking the court, which is more conservative than the 2017 bench, to re-examine the questions. DeSantis appointed four of the seven justices.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
—”Florida fund for injured kids wrongly stuck Medicaid with tab. Now it’s repaying $51 million“ via Carol Marbin Miller of the Miami Herald — Administrators of Florida’s long-troubled compensation fund for infants born with catastrophic brain injuries have resolved one of the program’s thorniest and longest-standing disputes: the claim that they avoided hundreds of millions in health care costs by raiding the safety net for impoverished Floridians. The Birth-Related Neurological Injury Compensation Association, or NICA, settled a three-year-old whistleblower complaint that alleged the program grew assets of nearly $1.7 billion partly by dumping health care and caregiving costs onto Medicaid, the state-federal insurer for poverty-stricken and disabled Floridians.
—“Florida diabetics scramble to find drugs suddenly popular for non-intended uses: weight loss” via Cindy Krischer Goodman — Florida diabetics are struggling to buy prescription drugs to help control their blood sugar now that the medications have gone viral on social media as a weight loss solution. The demand from dieters for Ozempic, sold as a liquid solution administered as an under-the-skin injection, has caused shortages of the medication and Trulicity, an injectable diabetes medicine. The buzz has created serious issues for people who actually need the prescribed medications to control diabetes.
—“Why most Tampa Bay hospitals are relaxing mask rules” via Christopher O’Donnell of the Tampa Bay Times — In another sign of life returning to something akin to normal during the COVID-19 pandemic, most local Tampa Bay hospitals have relaxed once-strict rules about patients, visitors and medical staffers wearing masks. The surgical mouth coverings — once mandatory at medical facilities to prevent the spread of the virus — are now merely recommended at most of the region’s major hospitals, although there are exceptions. The move follows new guidelines issued by the Centers for Disease Control and Prevention in September that said masks are no longer required in health care settings like hospitals, doctors’ offices and nursing homes in communities where COVID-19 transmission levels are low.
—“What happened to monkeypox? LGBTQ community appears to have quashed spread for now“ via Caroline Catherman of the Orlando Sentinel — Despite concerns that the end of summer vacation or even Pride events could further exacerbate monkeypox’s spread, the virus has fallen dramatically in the U.S. and Central Florida since peaking in August — though there’s no guarantee it will stay that way. Experts say the spread may have faltered mainly because of actions by the LGBTQ community. “The community that largely was affected was very responsible,” said Jill Roberts, an associate professor at the University of South Florida College of Public Health. “If that had not been the case, we would have definitely seen a lot of spread well beyond the men who have sex with men population and into other populations.”
—“Bridging breast and prostate cancer disparities among Blacks is focus of new Miami study“ via Michelle Marchante of the Miami Herald — With Black men and women at a higher risk of developing and dying from aggressive breast or prostate cancer, a new Miami study is seeking to understand better how to detect and treat the diseases across Black communities in the United States, the Caribbean and Africa. Researchers at Sylvester Comprehensive Cancer Center will work to identify cancer-causing mutations among U.S. Blacks diagnosed with breast or prostate cancer, including in the Miami area, as well as Blacks in the Bahamas, Barbados, Haiti, Jamaica and Trinidad and Tobago in the Caribbean.
— PENCIL IT IN —
Happy birthday to Sen. Geraldine Thompson.
Happy birthday to Rep. Rick Roth.
11 a.m. The Statewide Human Trafficking Council meets.
2 p.m. AHCA holds a public hearing on proposed changes to Rule 59A-4.110 regarding food and nutrition services. Place: AHCA, Building 3 Conference Room C, 2727 Mahan Drive, Tallahassee, 32308.
10 a.m. Florida House Organizational Session. Place: House Chambers, The Capitol, 400 S. Monroe St. Tallahassee, 32399.
10:30 a.m. Florida Senate Organizational Session. Place: Senate Chambers, The Capitol, 400 S. Monroe St. Tallahassee, 32399.
12:30 p.m. Post-Session media availability with Speaker Paul Renner. Place: Room 333 The Capitol, 400 S. Monroe St. Tallahassee, 32399.
1:30 p.m. Post-Session media availability with Senate President Kathleen Passidomo. Place: Senate Chamber, The Capitol, 400 S. Monroe St. Tallahassee, 32399.
1:30 p.m. The Medicaid Medical Care Advisory Committee meets. The meeting will be virtual. Participants must register in advance for the meeting.
Happy birthday to Sen. Linda Stewart.
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