Checking the heartbeat of Florida well being care information and coverage

Checking the heartbeat of Florida well being care information and coverage

Welcome again to Prognosis, a vertical that focuses on the crossroads of well being care coverage and politics.

Florida Medicaid company officers have scheduled a two-hour public assembly on July 8 to debate a proposed ban on Medicaid protection of gender dysphoria in Florida.

Anticipating that the proposed modifications may draw a crowd, the Company for Well being Care Administration opted to carry what might be the one public assembly within the auditorium of the Florida Division of Transportation constructing as a substitute of its headquarters.

The proposed modification revealed by the Ron DeSantis administration final week would add language to an present Medicaid rule that bans Medicaid from offering protection for gender dysphoria. It excludes protection of puberty blockers, hormones and hormone antagonists, intercourse reassignment surgical procedures, and different procedures that alter major or secondary sexual traits.

Ron DeSantis provides a tough no on Medicaid protection of gender dysphoria.

Furthermore, the proposed language bans physicians from contemplating dysphoria and gender-affirming remedy when figuring out what’s “medically crucial” for his or her sufferers.

The administration is transferring to change the state coverage by amending a rule that applies to all Medicaid-participating suppliers. The underlying rule permits suppliers to restrict the variety of Florida Medicaid recipients they deal with however makes clear that hospitals can not refuse to offer emergency care, and suppliers are precluded from denying providers primarily based solely on “race, creed, colour, nationwide origin, disabling situation or incapacity, in accordance with federal anti-discrimination legal guidelines.”

If profitable, gender dysphoria can be the one analysis within the rule for which remedy is banned. However Florida does restrict different Medicaid protection within the rule. As an illustration, the regulation prohibits Medicaid from offering protection for folks in jail. The rule additionally makes clear that “aliens” qualify for “emergency” Medicaid providers, however as soon as the emergency not exists, Medicaid stops offering protection.

The assembly begins at 3 p.m. and ends at 5 p.m.


I welcome your suggestions, questions, and particularly your suggestions. You possibly can e-mail me at [email protected] or name me at (850) 251-2317.

Medicaid procurement heats up

There are indicators that work on the state’s Medicaid managed care procurement is starting.

Three medical care advisory subcommittees are scheduled to satisfy this week — two of the committees handle kids’s well being care points, and the third committee will focus on psychological well being and substance abuse points. An extended-term care committee met final week. The subcommittees are half of a bigger medical Care advisory Committee that’s required to satisfy by federal regulation.

Everybody has an opinion on revamping the state’s Medicaid system.

AHCA additionally made out there this week the responses to its request for Data soliciting enter on methods the state’s Medicaid managed care program might be improved earlier than the state points its subsequent solicitation.

The responses can be found right here, with a abstract of responses under ….

— Managed care plans say

Florida Affiliation of Well being Plans desires the state to streamline the gathering of high quality metrics like how Medicare measures high quality metrics and discover “options to liquidated damages for high quality metrics.”

Aetna Higher Well being of Florida, Inc. requested the state to work with managed care plans to determine alternatives to reinvest any financial savings into the Florida communities.

AmeriHealth Caritas Florida recognized a number of alternatives for AHCA to cut back the executive burden for the plans, suppliers, and the state by eliminating the obligatory web site visits for each major care doctor each three years. “Different states have eliminated this requirement from their Medicaid program, because it creates an undue administrative burden on the supplier workplaces (that) should accommodate this request from each plan with whom they contract,” the plan wrote in its response. Moreover, the plan stated the accuracy of enrollee info must be improved: “There may be vital waste of economic assets and time in addition to misplaced alternative related to failed makes an attempt to contact enrollees that’s brought on by inaccurate enrollee contact info.”

Florida Medicaid managed plans provide options to make the system higher.

Neighborhood Care Plan urged that the state alter the present auto-assignment algorithm to reward plans with increased HEDIS high quality scores to obtain preferential auto-assignment. It additionally recommends requiring enrollees to offer their most well-liked communication methodology (by telephone, textual content, e-mail, or postal mail) on the time of utility. The well being plan additionally really useful permitting plans to ask members for a most well-liked methodology of communication along with the contact info.

Humana Medical Plan was the one plan to submit a redacted response. In its response, the well being plan really useful that the state enable contracted well being plans to telehealth to handle community adequacy points and “to offer vital help providers to low-risk recipients or these needing comply with up.”

Molina Healthcare of Florida stated the state ought to require managed care plans to explain and submit group engagement plans as a part of the subsequent contract procurement. The group engagement plans mitigate the social determinants of well being care boundaries that contribute to well being disparities and stop financial self-sufficiency on the group degree and particular person member cohorts. The well being plans additionally really useful that AHCA require managed dental plans to ship month-to-month information to the medical managed care plans exhibiting the first dentist assigned to every youngster and adolescent member.

Merely Healthcare Plan. Inc. stated in its submission that doula providers have been important in narrowing the hole in beginning outcomes for minority ladies: “We, subsequently, advocate that doula providers be thought of as a completely coated, core profit to make sure all plans present doula care protection.” Merely additionally desires AHCA to develop the scope of providers specialty plans can provide to incorporate conventional managed medical help and long-term care advantages just like a complete plan. “This may allow a member in such a plan to have all their wants met by one plan together with (long-term care) providers.”

Sunshine Well being Plan stated the state ought to implement and preserve a single, payer-agnostic digital prior authorization (PA) submission answer. The plan additionally recommends that the state require managed care plans to rent Florida-based provider-engaging employees in every area they’re licensed to function to know higher the distinctive challenges suppliers and members face inside their communities. Moreover, the plan recommends that plans be required to share a normal set of well being info, together with the historic member profile, open authorizations, and suppliers seen within the final six months as members transition from well being plans.

Medical, hospitals, dental associations say

The Florida Medical Affiliation thinks the state ought to require all contracted Medicaid managed care plans which have had contracts for 2 years to reimburse all physicians on the Medicare charge. New entrants into the Medicaid managed care market would have two years earlier than they might be required to reimburse physicians on their panels on the Medicare charges. In its response, the group representing docs additionally says the company can implement the elevated fee underneath present regulation.

The Florida Hospital Affiliation desires the state to require contracted managed care plans to undertake a maternity medical dwelling mannequin for high-risk moms. The FHA stated in its response that it additionally desires the company to undertake parity patent insurance policies to help the insinuation of telehealth.

The Florida Dental Affiliation desires the state to make use of a particular identifier for sufferers with particular well being care wants who’re prone to require anesthesia/sedation for any dental service. The FDA stated in its response that to present these providers, dentists want entry to ambulatory surgical facilities and hospitals for sedation providers and that the contracted medical plans ought to assist dentists leverage entry to these areas.

Psychological well being and substance abuse suppliers say

The Florida Behavioral Well being Affiliation desires the state to get approval from the federal authorities to implement what is named the Neighborhood Licensed Behavioral Well being Clinic (CCBHC), which offers for future funds to CCBHC-designated suppliers. Furthermore, the group desires the state to “direct’ the Medicaid managed well being plans to contract with CCBHC suppliers as soon as the CCBHC program is carried out; there are 13 CCBHC grant awardees within the state and one other 33 suppliers just lately submitted grant purposes for CCBHC funding.

Florida Psychological Well being Advocacy Coalition desires the plans to coach staff who discipline telephone calls in regards to the nature and remedy of protocols for treating folks with severe psychological sickness based on its response.

The Florida Affiliation of Managing Entities desires managed care plans to contract with managing entities for finest apply applications for pregnant and postpartum ladies, particular prenatal care to moms, kids/adolescents, households, adults and senior fashions, homeless, veterans, diversion and hospital bridge, respite, built-in care, and good justice.

Extra ideas from different suppliers

The Florida Alliance of House Care Providers desires the state so as to add a shopper value enhance to deliveries of sturdy medical gear providers. The group additionally desires the sturdy medical gear business to have a consultant on the Medicaid Medical Care Advisory Committee.

The Florida Affiliation of Neighborhood Well being Facilities desires the state to acknowledge federally certified well being facilities, which give care to one-in-seven Medicaid enrollees, as important suppliers for the upcoming procurement.

The House Care Affiliation of Florida stated that dwelling well being care suppliers are paid on outdated fee-for-service payment schedules, and that managed care plans should not paying suppliers inside 120 days as required by regulation.

The Florida Hospice & Palliative Care Affiliation urged that managed care plans be required to “settle for the affected person’s selection for hospice supplier and contract with that hospice to offer the Medicaid room and board portion of the service.”


The Division of Well being proposes creating Rule 64J-1.024 to ascertain disciplinary tips for the professions of emergency medical technician, and paramedic, licensed emergency medical providers suppliers, and EMT and paramedic coaching applications to make clear the vary of self-discipline. Extra right here.

AHCA proposes amending Rule 59A-36.021 relating to licensure of assisted dwelling amenities and the Florida Constructing Code. Extra right here.

AHCA proposes amending Rule 59A-36.012 relating to the tasks for meals service requirements inside assisted dwelling amenities. Extra right here.


— AARP Florida’s Zayne Smith has been promoted to director of Advocacy. Karen Murillo joins AARP because the affiliation’s Advocacy Supervisor. Murillo is a former Assistant Statewide Prosecutor for the Lawyer Common’s Workplace.

Congratulations to Zayne Smith on her new position at AARP.

Joseph T. Nezgoda, M.D., MBA, was put in as president of the Florida Society of Ophthalmology (FSO) Nezgoda is a former researcher on the world-renowned Nationwide Institutes of Well being. He graduated with honors from Georgetown College and attended medical college at Rutgers (UMDNJ)-Robert Wooden Johnson Medical College, the place he acquired the Excellence in Instructing and Gold Humanism Awards. He skilled at Mount Sinai (New York), Einstein Medical Middle, the Cleveland Medical Middle, and the College of California. He focuses on macular degeneration, diabetic eye illness, and different severe blinding eye illnesses. He practices in West Palm Seaside, Delray Seaside and Boca Raton. Tampa ophthalmologist David A. Eichenbaum, was put in as president-elect.

Raquel Goldhardt, Zelia M. Correa, Luxme Hariharan and Courtney Bovee, had been put in because the vice president of Advocacy, vice president of training, vice chairman of outreach, and secretary/treasurer, respectively.


In case you missed them, here’s a recap of different vital well being care coverage tales coated in Florida Politics this previous week.

One other VAX dust-up: Florida docs and hospitals can order COVID-19 vaccines for kids underneath 5, now that the federal authorities has given its preliminary OK to the photographs, however the state received’t be ordering any vaccines for county well being departments. Florida was the one state that didn’t pre-order the vaccines for kids. White Home Coronavirus Response Coordinator Ashish Jha advised reporters that Florida has now ordered vaccine doses designed for kids. The federal authorities stated the DeSantis administration reversed its coverage, however the DeSantis administration denied that was the case noting that the plan all the time was for well being care suppliers to position their orders, which they’ll now do.

The newest touchpoint between Florida and the feds — vaccines for toddlers.

No love for Tally: Florida’s high IT officer says getting proficient senior-level IT employees to work for the state of Florida is an uphill battle, and he named low wages in addition to dwelling in Tallahassee, the state capital that’s a whole bunch of miles away from the state’s main metro areas, among the many high causes.

Up, up, up: The variety of complaints regarding Florida’s Medicaid managed long-term care program has risen just lately. Paula James, the AHCA administrator for the Bureau of Plan Administration Operations, offered information exhibiting 312 calls in Might complaining in regards to the contracted managed care plans that present long-term care providers within the state.

Alternatives: Inside DeSantis’s finances accepted earlier this month, the Legislature submitted a Native Help Grants Program, successfully extending the appropriations mission request interval into the summer time months. In a memo to Home members on Monday, Speaker Chris Sprowls briefed members on how they’ll search funding for the initiatives of native governments, training entities, and privately operated applications of their districts. Lawmakers pays for the initiatives with $175 million in federal stimulus money acquired via the Federal Coronavirus State Fiscal Restoration Fund, made out there by President Joe Biden and Democrats in Congress.

RIP: Jack Capra, Interim Common Counsel on the Division of Elder Affairs (DOEA) and a U.S. Navy veteran who served alongside Gov. Ron DeSantis in Guantánamo Bay, died. Capra and his service canine, Rocco the black labradoodle, had been well-known in authorities circles. Along with his service, Capra was an advocate for service members and repair canines, together with as an early graduate of K9s for Warriors.


Other than protection by Florida Politics, these tales are worthy of your time.

—“There’s a well being hole in South Florida’s Black communities. Right here’s what may be accomplished” through Grethel Aguila of the Miami Herald — When Melida Akiti’s son-in-law suffered from extreme belly ache, he trudged over to pressing care. He checked in and waited, solely to be discharged with nothing however Tylenol. The expertise is why he — and plenty of different folks of colour — hate hospital visits. At midnight, he referred to as Akiti, a vice chairman at Memorial Healthcare System, in excruciating ache. She took him to the identical pressing care middle and demanded to know why the employees ignored his illnesses. Then the matter was taken significantly — significantly sufficient to hospitalize him for 4 days. He may have died with out remedy.

A level of racial disparity in well being care nonetheless exists in South Florida

—“Florida surpasses 75,000 COVID-19 deaths; two-thirds of state in high-risk class for group unfold” through David Schutz and Cindy Krischer Goodman of the South Florida Solar-Sentinel — Florida reached a grim milestone this week: Greater than 75,000 folks within the state have died of COVID-19. The brand new demise toll comes as COVID hospitalizations are rising to ranges final skilled throughout Florida’s winter surge and two-thirds of the counties within the state — together with South Florida’s three counties — have moved into the pink zone for elevated danger of group unfold. Over the previous two weeks, one other 506 COVID-related deaths had been reported in Florida and greater than 300 had been admitted to Florida hospitals with the virus, a sign that some Floridians are at substantial danger from the omicron strains now circulating.

—“Affected person demise spurs Orlando Well being nurses to sound alarm about staffing” through Caroline Catherman of the Orlando Sentinel — The suicide of a affected person at Orlando Regional Medical Middle final month has fueled unrest amongst nurses about what some describe as extreme understaffing on the hospital, although a state assessment discovered the ability was not at fault for the demise. On Might 27, a TikTok consumer generally known as Nurse Nander posted a video sharing a number of broadly percolating rumors, together with that short-staffing contributed to the Might 16 suicide — by which a affected person broke open the window of his eighth-floor room and jumped to his demise. Within the following weeks, the video garnered over 1.5 million views. Feedback about brief staffing and poor working situations at Orlando Well being poured in from dozens of customers who claimed to be staff.

Florida well being officers warn of rising meningococcal outbreakthrough Christopher O’Donnell of the Tampa Bay Occasions — State well being officers are warning the general public a few rise within the variety of statewide circumstances of meningococcal illness. Nevertheless, there are few circumstances within the Tampa Bay area. The illness first seems as a flu-like sickness, with fever, headache and a stiff neck, and quickly worsens, based on the Facilities for Illness Management and Prevention. The 2 commonest sorts of meningococcal infections are meningitis and septicemia, each of which may be lethal in a matter of hours. In meningitis, micro organism infect the liner of the mind and spinal wire and trigger swelling.

—“Inside one abortion clinic, indicators of nationwide struggles” through Gabriela Bhaskar and Abby Goodnough of The New York Occasions — At a Deliberate Parenthood well being middle on Florida’s Gulf Coast, new restrictions on who can get an abortion are shaking up routines and creating challenges for the clinic’s sufferers, docs and nurses. The middle in Fort Myers had seen a gentle inflow of sufferers from Texas since final September when a ban on all however the earliest abortions took impact there, and from different states which have tightened entry to the process over the previous yr. Additionally it is adjusting to a ready interval that took impact in Florida in April after years of litigation, requiring sufferers searching for an abortion to have an ultrasound after which wait at the least 24 hours earlier than returning for the precise process.



Blissful birthday to Reps. Chuck Clemons and Linda Chaney.

Linda Cheney and Chuck Clemons lead off every week crammed with blissful birthdays.

11 a.m. The Florida Democratic Occasion press availability on the DeSantis administration’s determination to not pre-order youngster vaccines.

2 p.m. The Medicaid Medical Care Advisory Committee (MCAC) Subcommittee for Behavioral Well being/ Substance Use meets. Assembly hyperlink right here. Electronic mail [email protected] for a duplicate of the agenda.


Blissful birthday to Rep. Daniel Perez.

9 a.m. The Florida Board of Therapeutic massage Remedy meets. Name (877) 309-2073; participant code: 985532741.


Blissful birthday to Rep. Pleasure Goff-Marcil.

10 a.m. The Medicaid Medical Care Advisory Committee for Youngsters and the state Foster Care System meets. Assembly hyperlink right here. Electronic mail Timo [email protected] for a duplicate of the agenda.

1 p.m. Medicaid Medical Care Advisory Committee (MCAC) Dental Subcommittee meets to debate dental care for kids. Assembly hyperlink right here. Electronic mail [email protected] for a duplicate of the agenda.


Blissful birthday to Rep. Bryan Avila.


Blissful birthday to First Woman Casey DeSantis, in addition to Reps. Mike Beltran, Dianne Hart and Lawrence McClure.

Blissful Birthday, First Woman DeSantis. Picture through Governor’s Workplace.

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