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Analysis for 12.1.22: Checking the heartbeat of Florida well being care information and coverage – Florida Politics

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

Almost 900,000 Floridians have signed up for medical health insurance underneath the federal well being care trade, in response to the newest information supplied by the Facilities for Medicare & Medicaid Providers.

Florida has routinely led the nation within the variety of residents who depend on the trade applied as a part of the Reasonably priced Care Act, also called Obamacare. And it’s once more main the nation throughout the open enrollment interval.

The information exhibits that, of practically 3.4 million People enrolled within the trade, about 897,000 have been from Florida.

The Reasonably priced Care Act may be very well-liked in Florida.

This yr’s open enrollment interval started Nov. 1 and runs till Jan. 15 for states that depend on the federally run Healthcare.gov platform.

Federal officers say thus far this yr, there’s a 17% enhance within the variety of individuals total who’re utilizing both federal or state-run exchanges.

“We’re off to a powerful begin — and we won’t relaxation till we are able to join everybody doable to well being care protection this enrollment season,” Well being and Human Providers Secretary Xavier Becerra mentioned when the newest numbers have been introduced late final week.

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

— Jason Weida for AHCA? —

Who will exchange Simone Marstiller after she leaves the Company for Well being Care Administration for the greener pastures of retirement?

The within phrase is that Jason Collins Weida, at present Marstiller’s Chief of Workers, is the front-runner for the place.

A graduate of the College of Connecticut School of Legislation, Weida was employed because the assistant deputy secretary for Medicaid coverage and high quality. He was named Chief of Workers over the Summer time after his predecessor, Cody Farrill, left for the Governor’s Workplace.

Who will fill the sneakers of Simone Marstiller?

Earlier than becoming a member of the company final yr, Weida labored as a former assistant U.S. lawyer in Boston for the Division of Justice and as counsel within the DOJ’s Workplace of Authorized Coverage in Washington, DC. In his position at DOJ, Weida oversaw drug diversion investigations of physician’s workplaces, pharmacies and hospitals.

Weida, who makes $131,725 yearly, was admitted to the Florida Bar Affiliation in Might and is a member of the Younger Attorneys part.

Florida has a $110.1 billion budget for the current fiscal year. With a ($38.6 billion finances AHCA (which homes the state’s Medicaid program) accounts for practically one-third of the state’s spending. The following AHCA secretary will run the company because the state launches in earnest the re-procurement of Florida’s necessary Medicaid managed care program.

The multiyear contracts are the biggest within the state and are value tens of billions of {dollars} to the well being plans that submit successful bids.

Gov. Ron DeSantis introduced Marstiller’s retirement on Twitter final month. A longtime veteran of state authorities and a former appellate court docket choose, Marstiller’s retirement from authorities on the finish of the yr isn’t a surprise, given the brand new six-year lobbying ban that can take impact Jan. 1, 2023.

Present legislation bans company secretaries, comparable to Marstiller, from lobbying their former departments for 2 years following their departure. However there’s no ban on lobbying the Legislature.

All that adjustments Jan. 1, when the brand new six-year lobbying ban — permitted within the type of a constitutional modification by voters in 2018 — kicks in.

The ban is anticipated to play a consider individuals’s selections to remain on board with the DeSantis administration for a second time period. It additionally performs a consider recruiting individuals to take prime company positions.

— Adjustments really useful —

A blue-ribbon medical health insurance advisory panel is recommending lawmakers embrace a number of adjustments to make medical health insurance extra consumer-friendly and reasonably priced, together with capping at $35 the out-of-pocket prices for insulin.

On Wednesday, with out debate or dialogue, members of the Florida Well being Insurance coverage Advisory Board voted unanimously to ship eight recommendations to the Florida Legislature for consideration within the 2023 Session.

If permitted, starting Jan. 1, 2023, the month-to-month cost-sharing obligation for individuals with particular person or group medical health insurance or HMO insurance policies could be $35 a month. That may imply individuals with diabetes enrolled in these well being insurance policies would have the identical monetary protections that Congress agreed to provide Medicare beneficiaries earlier this yr with the passage of the Inflation Discount Act.

Different suggestions the board agreed to incorporate: prohibiting insurance coverage carriers from amending or eradicating a coated prescription drug throughout the coverage yr; requiring well being care suppliers to provide insureds a free copy of their medical report at take a look at; amending statutes to incorporate protection for fetal alcohol spectrum dysfunction, and increasing steadiness billing protections that apply to emergency air transportation to ambulance suppliers.

If an insured affected person switches well being plans midyear, they need to be given credit score for the out-of-pocket funds they’ve already made; the board agreed when it permitted a suggestion to permit deductibles to be “transferred” from one insurer to a different.

FHIAB member Louisa McQueeney with the left-leaning group Florida Voice for Well being Care launched all of the suggestions the board agreed to this week to ship to the Legislature.

Louisa McQueeney has suggestions for bettering medical health insurance choices.

Value noting: The Legislature traditionally has chosen to disregard suggestions from the FHIAB.

Florida legislation requires state group well being plans and well being insurance policies offered to giant employers to supply utilized behavioral evaluation companies for kids with autism.

Florida gives Medicaid-eligible minors underneath 21 recognized with autism or autism spectrum dysfunction with utilized habits evaluation companies.

However there isn’t a requirement that particular person medical health insurance plans (offered on or off the federal well being trade) or plans offered to small employers (corporations with 50 or fewer staff) present those self same ABA companies.

The FHIAB board additionally agreed to vary that and suggest that every one Florida licensed insurers and well being plans supply a minimum of one particular person and small group coverage with ABA protection.

— ABA rule doesn’t drive prices? —

Talking of ABA companies, the Company for Well being Care Administration on Wednesday launched a statement of estimated regulatory costs, commonly referred to as a SERC, for a controversial new rule in regards to the provision of ABA companies.

The SERC concludes that as a result of Medicaid is a voluntary program, the brand new regulation that requires ABA suppliers to conduct complete evaluations on poor kids twice a yr won’t enhance regulatory prices by greater than $200,000 and due to this fact doesn’t require legislative approval earlier than ratification.

Florida will get clear on well being care prices.

“When suppliers enroll in Florida Medicaid, they signal a Medicaid Supplier Settlement; pursuant to the Medicaid Supplier Settlement, an enrolled Medicaid supplier ‘agrees to adjust to native, state and federal legal guidelines, in addition to guidelines, laws, and statements of coverage relevant to the Medicaid program, together with the Medicaid Supplier Handbooks issued by AHCA,’” the SERC notes. “Rule 59G-4.125 establishes service necessities for suppliers who want to enroll and furnish habits evaluation companies underneath the Florida Medicaid program. Because of the voluntary nature of the connection between the Company for Well being Care Administration (Company) and suppliers whom this rule shall have an effect on, the Company has determined that Rule 59G-4.125 won’t enhance regulatory prices in extra of $200,000.”

The Florida Association of Behavioral Analysis (FABA), which has challenged the rule in administrative court docket, disagrees. The rule requires ABA suppliers to make use of certainly one of two proprietary exams (Vineland-3 or the BASC-3 PRQ) for the great assessments. As a result of ABA suppliers will probably be required to buy the exams, be educated on easy methods to administer the exams, after which prepare different suppliers to make use of the required assessments, the requirement will enhance the enterprise prices for ABA suppliers by $1 million within the first yr alone, FABA maintains.

AHCA initially refused to organize a SERC on the proposed rule.

FABA challenged the rule in a state administrative court docket after it requested the company to think about an alternate proposal that might value much less. The report exhibits that the court docket has been placed on maintain till subsequent week to permit the events to judge a lower-cost regulatory various that would finish the litigation.

Division of Administrative Listening to Choose Gar W. Chisenhall ordered the events to file a joint standing report with DOAH on or earlier than Dec. 6, stating whether or not the dispute has been settled.

The Autism and Developmental Disabilities Monitoring (ADDM) Community on the Facilities for Illness Management and Prevention launched a study estimating one in 44 8-year-old kids in 2018 was recognized with autism spectrum dysfunction (ASD).

— Work to be accomplished —

Florida officers on Thursday acknowledged World AIDS Day together with others around the globe by noting that whereas steps have been made in treating these with HIV/AIDS, there’s “nonetheless work to be accomplished.”

In keeping with the Florida Division of Well being (DOH), the speed of HIV deaths amongst all individuals recognized with HIV has declined 31% over the last decade. In 2021, there have been greater than 120,000 individuals with HIV within the state, together with greater than 4,700 who had been just lately recognized.

“We’ve got come a good distance because the first HIV prognosis, however there’s nonetheless work to be accomplished to finish the HIV/AIDS epidemic,” mentioned Florida Lt. Gov. Jeanette Nuñez in an announcement. “I’ve been working instantly with DOH and HIV stakeholders this previous yr to debate how we are able to additional our progress in preventing HIV/AIDS. We should proceed to interrupt down obstacles to make sure Floridians can entry improved and constantly evolving HIV therapy and prevention choices. These are essential to serving to Floridians stay lengthy and wholesome lives.”

Jeanette Núñez says extra consciousness is essential to victory over the AIDS epidemic. Picture through Colin Hackley.

Florida Surgeon Basic and DOH Secretary Dr. Joseph Ladapo mentioned World Aids Day is significant to boost consciousness in regards to the a number of forms of HIV prevention and therapy choices. The forms of therapy embrace each day by day capsules in addition to long-acting injectables.

“On at the present time, we honor the lives misplaced to HIV by in search of collaborative and progressive options to assist us finish the HIV/AIDS epidemic in Florida and throughout the globe,” Ladapo mentioned. “In the present day can also be a day to extend consciousness of the HIV therapy and prevention choices accessible to individuals. Lengthy-acting injectable medicines promote elevated accessibility to HIV prevention and therapy, however individuals must find out about them, discuss them, and perceive the place and easy methods to entry them.”


— The Board of Pharmacy is proposing updating Rule 64B16-28.1191 to handle the expiration dates of unclaimed prescriptions. Extra here.

— The Board of Chiropractic Drugs is amending Rule 64B2-13.004 to replace the necessities for persevering with training. Extra here.

— The Board of Respiratory Care is amending Rule 64B32-6.004 to replace its persevering with training necessities. Extra here.


Tyler David Jefferson has registered to foyer for the Florida Division of Elder Affairs.

Julie H. Fess has registered to foyer for VERICARE Inc.


Richard Learn has been named the HCA East Florida Division Chief Monetary Officer place. Learn has served because the HCA Florida Kendall Hospital Chief Monetary Officer for the final two and a half years. He begins his new submit on Jan. 1, 2023.

Dana Begley has been chosen to function Lee Well being’s new vice chairman of wellness and restoration.

Congratulations to Dana Begley on her transfer up in Lee Well being.

Caren Bock, MBA, MSN, R.N., LSSBB, has been named the Chief Nursing Officer for HCA Florida Woodmont Hospital. She begins on Dec. 12.


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

What’s the rush?Florida assisted residing amenities (ALF) are elevating questions on new emergency administration laws proposed by state well being care regulators. AHCA held an hourlong workshop Tuesday with ALF suppliers, native emergency administration officers, and others who flagged their considerations with the proposed regulations.

Not surprisingDeSantis and Republican lawmakers on the marketing campaign path repeatedly pointed to sky-high inflation as a scourge pinching Floridians’ pocketbooks, arguing it’s sparked primarily by indulgent spending by President Joe Biden and fellow Democrats in Congress. However new legislative leaders aren’t prepared to extend Florida’s jobless advantages, although the final time lawmakers raised the utmost weekly unemployment fee, Ricky Martin’s “Livin’ La Vida Loca” was the highest tune on the charts.

Ron DeSantis blames Joe Biden for inflation, however what has Florida accomplished to assist?

Staying putDeSantis continued his pattern of saying his second time period company heads on social media by informing these in The Course of that Division of Kids and Households (DCF) Secretary Shevaun Harris is staying on board. “Shevaun Harris has accomplished a wonderful job serving Florida’s households because the Secretary of (DCF),” DeSantis tweeted Monday. “She has fostered innovation and ensured accountability. I sit up for persevering with working together with her this upcoming time period.”

A healthy ‘hoodMiami-Dade County is on monitor to obtain $1.4 million in federal funding to help transit initiatives in its northeastern and southeastern corners. The Miami-Dade Division of Transportation and Public Works will get $840,000 to advance the event of a grasp plan for transit-oriented developments — mixed-use, pedestrian and bicycle-friendly development initiatives meant to function employment, housing and industrial hubs — at or between the hall’s 5 stations. One other $533,000 will go to Homestead to assist finance transit-oriented developments round three rapid-bus stations alongside the South Corridor.

Seismic shift — Florida’s mammoth well being care company is transferring ahead with one of many state’s most vital and costly contracts. And it’s going to be fairly an endeavor. AHCA will finally be tasked with awarding new six-year contracts to a handful of managed care corporations, making them answerable for the well being care of greater than 4.24 million residents.


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

Florida seniors have the worst medical debt in the U.S., report saysthrough Briona Arradondo of Fox 13: “Should you’re out of labor, then how do you pay your lease, your mortgage, purchase meals for the desk? And sadly, what occurs is it’s these issues, comparable to medical payments, that may fall by the wayside,” mentioned JoAnn Bross, the director of medical, social work and religious care companies at Gulfside Healthcare Providers in Tampa Bay. A brand new report from Alignment Healthcare discovered simply how far these payments fall. It mentioned “34% of these with medical debt in Florida” had payments “totaling a minimum of three months of residing bills.” Florida’s seniors have the worst medical debt within the nation, and the issue may very well be even higher.

Seniors in Florida are drowning in well being care debt.

Florida HIV cases are increasing — and many people don’t know they have itthrough Cindy Krischer Goodman and Caroline Catherman of South Florida Solar-Sentinel: Whereas many components of the nation have HIV underneath management, Florida leads the nation in new infections. Almost 5,000 individuals a yr in Florida are recognized with HIV, a quantity that hasn’t budged a lot within the final 10 years regardless of the nation experiencing an 8% decline total. About 120,000 individuals in Florida stay with HIV and as many as 17,700 extra are undiagnosed and certain spreading the virus to others. Because the world acknowledges its progress on World AIDS day, Dec. 1, Florida is caught prior to now.

Millions of dollars to flow into region from an opioid settlement with large pharmaciesthrough Martin E. Comas of Orlando Sentinel: Central Florida counties stand to obtain practically $15 million from an estimated $13.1 billion settlement to resolve lawsuits in opposition to the nation’s largest pharmacies over their roles within the opioid disaster. Many of the cash will probably be distributed by Florida to native governments over the following 18 years. It’s anticipated to pay for drug therapy and academic applications, along with buying gear for legislation enforcement and first responders, comparable to units used to manage Narcan, a medication used to deal with overdoses.

Hillsborough has a free health care plan for residents who can’t get Medicaid. It needs more members through Stephanie Colombini of WUSF: As certainly one of 11 states within the U.S. that has not chosen to broaden Medicaid, Florida restricts its program to kids, pregnant individuals, caretakers of minors and a few seniors and residents with disabilities. This leaves 1000’s of residents who stay on low incomes however don’t meet the factors, struggling to entry well being care. The Hillsborough program provides assist to county residents who can’t qualify for Medicaid or entry different well being care advantages. In keeping with Philip Conti, Hillsborough’s well being care companies supervisor, a lot of the greater than 13,000 individuals on the county plan are middle-aged adults. Many lack secure jobs and housing.



Completely satisfied birthday to Sen. Debbie Mayfield.


Completely satisfied birthday to Sen. Keith Perry.

Cheers to Keith Perry for one more journey across the solar.

9 a.m. Molina Healthcare of Florida workers volunteers will distribute luggage of meals to greater than 500 households. Farm Share Meals Distribution Drive-Through sponsored by the MolinaCares Accord. Place: Higher Room Meeting of God 19701 127th Ave., Miami.

12:30 p.m. Molina Healthcare Bears supply at the side of Young Dreams Community Outreach will ship 100 stuffed bears to the Nicklaus Children’s Hospital pediatric ward. Place: 3100 NW 62 Ave., Miami.


8:30 a.m. The Board of Nursing’s Training and Credentials “B” Committee meets. Place: SouthBank Resort, Jacksonville Riverwalk, 1515 Prudential Dr. Jacksonville.


8:30 a.m. The Board of Nursing Credentials “A” Committee and the Training and Credentials “B” Committee meet. Place: SouthBank Resort, Jacksonville Riverwalk, 1515 Prudential Dr., Jacksonville.

9 a.m. The Bureau of Emergency Medical Oversight, EMS Advisory Council’s 911 Public Security Telecommunicator Committee meets. The assembly hyperlink is here. Assembly ID: 210186949790.

4:30 p.m. Full Pediatric Cardiac Technical Advisory Panel (PCTAP) meets. Webinar here.

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