Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
This week, an ongoing legal tussle over Florida’s ban on “vaccine passports” will go before an appellate court.
Pushed on by Gov. Ron DeSantis, state legislators a year ago passed a law that codified an executive order from the Governor that blocked businesses or government entities from requiring proof of vaccination.
Norwegian Cruise Line Holdings challenged the law in federal court and won a preliminary injunction last August that allowed it to require guests to be vaccinated before boarding. U.S. District Judge Kathleen Williams, appointed by former President Barack Obama, blocked the law on several grounds. She said Florida had not provided factual or legal reasons for the law and said that “documentary proof of vaccination will expedite passengers’ entry into virtually every single country.”
Florida appealed the ruling, and although the judge’s ruling only applied to Norwegian, state officials said they would not enforce the vaccine passport ban for all cruise lines until a decision was reached on the injunction.
Months later, the case will finally be heard Wednesday in Miami by a panel of judges from the 11th Circuit Court of Appeals.
The landscape over COVID-19 has changed since the lawsuit was first filed, including that the Centers for Disease Control & Prevention has dropped its restrictions (which came after Florida successfully challenged them) and its risk advisories about cruises.
Charles Cooper, a Washington D.C. attorney representing State Surgeon General Joseph Ladapo, noted in a court filing earlier this month that Norwegian has dropped its vaccination requirement for children under 12 and that some destinations are allowing negative test results in place of shots.
Derek Shaffer, a lawyer for Norwegian, responded last week by saying that the changing nature of testing and quarantining requirements is precisely why the cruise lines should be allowed to require proof of vaccinations. He added that Norwegian dropped the vaccine requirement for children based on recent data but noted that the cruise line still maintains a standard that 95% of those on the ship are vaccinated.
During an earnings call last week, Norwegian CEO Frank Del Rio acknowledged the line planned to drop its vaccination requirement to 90% for one brand operated by the cruise line due to a change in CDC recommendations. But Del Rio contended that the approach used by the company had resulted in a lower incidence of COVID-19 compared to the population at large. A transcript from the call quotes Del Rio saying, “we do not prioritize short-term gains at the expense of jeopardizing our long-term brand equity and industry-leading pricing in the process” and that the company “prioritized the health, safety and well-being of our guests, crew and the communities we visit above all else.”
The expense of jeopardizing our long-term brand equity and industry-leading pricing in the process” and that the company “prioritized the health, safety and well-being of our guests, crew and the communities we visit above all else.”
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— Six of one —
The Agency for Health Care Administration has extended for another six months a ban on new applied behavior analysis group providers from enrolling in the Medicaid program in Miami Dade and Broward counties.
In its announcement Friday afternoon, the AHCA said it is the “final extension” and that the moratorium on the providers of ABA services used to treat children with autism expires Nov. 13.
The ban does not allow any new provider group to enroll in those two counties, even if the group is an existing Medicaid ABA provider in other areas across the state.
The provider enrollment ban in Miami Dade and Broward does not prevent an applied behavior analysis provider working independently from joining a Medicaid ABA group provider already operating in those two counties.
Applied behavior analysis is a therapy based on the science of learning and behavior, according to Autism Speaks. Medicaid costs for applied behavior analysis therapy doubled between 2016 and 2018, with state officials blaming unqualified providers who render unnecessary services. Centers for Medicare & Medicaid Services (CMS) granted Florida a “temporary moratorium” on new ABA provider enrollment in Miami-Dade and Broward counties.
In the meantime, the state has taken steps to ferret out potential fraud and has required ABA professionals to be credentialed by the Behavior Analyst Certification Board. There has also been a move afoot to change the Medicaid reimbursement rules, including requiring the parent or guardian of an autistic child to participate in every ABA treatment session. Representatives from the Florida Association for Behavior Analysis, who attended a workshop the state held on the proposed changes in April, have criticized the suggested changes.
— Survey says … —
Residents who are 50 years and older accounted for 64% of Florida voters in 2018, making them a powerful voting bloc in the upcoming elections. A recent AARP survey shows that more than half (56%) are worried about their retirement plan solvency and having enough money to retire (50%). Forty-eight percent worry about the availability of public assistance benefits.
The concerns may not be surprising given that 28% of survey respondents reported a reduction in income and 24% reported a decline in savings in the last two years.
Meanwhile, Medicare benefits and staying mentally sharp were the top health concerns noted by 79% of survey respondents. Health insurance (71%), health care expenses (68%), and declining physical health (64%) were also reported among their top concerns.
Again, the findings underscore their firsthand experiences.
Declines in physical health (25%), vision or hearing (19%), and mobility (16%) were reported to have occurred in survey respondents in the last two years, as was memory loss (8%).
Meanwhile, 64% of Florida AARP members say they worry about staying in their homes and continuing to drive, while 62% worry about the availability of long-term care.
“Floridians 50+ made up 64% of Florida voters in 2018. It’s clear that they have significant influence in the Sunshine State. The 50+ will be the deciders in the 2022 midterm elections. It’s time to recognize and better understand what matters most to them,” AARP Florida State Director Jeff Johnson said in a prepared statement announcing the survey findings.
AARP contacted 171,805 members from across the United States and the District of Columbia, asking them to participate in the survey either by mail or online between May 20 and Aug. 18, 2021. A total of 20,116 members completed and returned surveys for a response rate of 12%. In Florida, 9,865 members were contacted, with 1081 completing and returning surveys. The overall response rate for Florida was 11%.
—Training emergency —
Florida is one of six states with the most significant increases in the number of emergency medicine residency programs between 2013 and 2020, according to a recently released analysis of the emergency medicine workforce published in the Annals of Emergency Medicine. A review of Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency programs from 2013 to 2020 showed that the number of residency programs increased from 5 to 19. Michigan is the only other state to increase the number of emergency medicine programs by 15 during that period, going from 11 programs to 25. New York. Ohio, Pennsylvania, and California also had increases in residency programs for emergency medicine.
The study’s authors note that the new emergency medicine residencies are in urban areas and states already with emergency medicine residencies. The report was published days before the 47th annual National EMS Week. Former President Gerald Ford launched EMS Week in 1974. This year’s theme: “Rising to the Challenge.”
— Baller to healer —
Dr. Myron Rolle will speak at the FSU Alumni Association Ballroom on May 23 at 7 p.m. to discuss his new book “The 2% Way: How a Philosophy of Small Improvements Took Me to Oxford, the NFL and Neurosurgery.” Rolle played for the FSU Seminoles football team between 2006-08, earned the Rhodes scholarship for study at Oxford; played three years as a safety in the NFL; and graduated from FSU Medical School in 2017. Now 35, Rolle is a fifth-year neurosurgery resident at Massachusetts General and Harvard Medical School. He is the founder and chair of the Myron L. Rolle Foundation, a nonprofit organization dedicated to supporting global health, wellness, education, and other charitable initiatives benefiting children and families in need.
Midtown Reader in Tallahassee sells copies of the book and will provide customers with a free general admission ticket to the event. There also will be an opportunity to attend a private VIP reception and priority book signing between 6 p.m. and 7 p.m. VIP tickets can be purchased here.
The Alumni Association Ballroom is at 1030 West Tennessee St., Tallahassee; Midtown Reader is at 1123 Thomasville Rd., Tallahassee.
— RULES —
The Florida Board of Medicine proposes amending Rule 64B8-9.0091 to add the American Accreditation Commission International (AACI) as a board-approved accrediting organization. More here
The Florida Board of Medicine proposes amending Rules 64B8-15.001; 64B8-15.002; and 64B8-15.003 to clarify and update the rule text, update specific reference material and repeal a rule no longer necessary. More here.
The Florida Board of Medicine proposes amending Rule6 4B8-14.002 regarding the certification of foreign medical programs to remove the abbreviations and definitions no longer in use. More here.
— ROSTER —
— Palm Beach Gardens Medical Center named Tiffany Berry its new chief financial officer. Berry previously served as the CFO of Northwest Health-Porter Hospital, a 301-bed hospital with multiple campuses in Indiana.
— Arvind Agarwal, chair of Florida International University’s Department of Mechanical and Materials Engineering and director of the university’s Advanced Materials Engineering Research Institute, is part of an interdisciplinary research team that has made a significant breakthrough with the development of a miniature heart chamber, the university announced.
— A pair of University of Florida scientists have been awarded a three-year $1 million grant from the National Cancer Institute to analyze the effectiveness of Dignity Therapy. Co-leading research efforts are Carma Bylund, a behavioral scientist in the University of Florida College of Medicine’s health outcomes and biomedical informatics department and a UF Health Cancer Center member. Susan Bluck, Ph.D., a life span developmental psychologist and gerontologist in the UF College of Liberal Arts and Sciences’ department of psychology.
Developed in 2002 by Harvey Chochinov, M.D., Ph.D., Dignity Therapy aims to help adults with cancer complete important psychological tasks such as preparing legal documents and sharing life lessons. Chochinov, a distinguished professor of psychiatry at the University of Manitoba and senior scientist at the Cancer Care Manitoba Research Institute, will serve as a consultant.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— Just in time: A new $10.5 million long-term care facility for people with developmental disabilities will be built in Madison County in the next 18 months. The Agency for Health Care Administration announced that Sunrise Community, Inc.. is taking advantage of a 2020 law championed by Sen. Gayle Harrell and Rep. Colleen Burton that allows it to build an ICFDD, or intermediate care facility for the developmentally disabled, without obtaining a “certificate of need” (CON). The CON exemption expires on July 1.
— Another attempted shutdown, another challenge: Alleging a pattern of intentional or negligent acts that caused the death of one resident and put others at risk and claimed the facility isn’t financially stable, state health care regulators refused to renew the license of a Tallahassee assisted living facility. Woodmont, A Pacifica Senior Living Community, is challenging the move, arguing that the Agency for Health Care Administration is unfairly rejecting the renewal application based on allegations from two separate survey inspections at the center of a separate legal tussle between it and the agency.
— Demings v Rubio: With the expected release of a Supreme Court of the United States opinion next month that would reverse the abortion rights decision of Roe v. Wade, the profoundly emotional topic already has become front-and-center in campaigns. Rep. Val Demings recently blasted her expected U.S. Senate race opponent, Republican Sen. Marco Rubio, as “an extremist.” My opponent believes that a woman should not have the right to an abortion regardless of the circumstances. He believes women should not have the right to an abortion even in the event of incest and rape,” Demings said, characterizing Rubio’s position. “I investigated sexual abuse cases and rape cases and doggone it, we are not going for that, are we, Florida?” Demings, the former Orlando police officer, challenged the crowd.
— Avoiding losses: What’s being called the most comprehensive Harvard University spearheaded a recently released study that generally found that high-poverty schools spent more weeks in remote instruction and that these more disadvantaged schools suffered more significant losses in academic achievement during the second school year affected by the COVID-19 pandemic. The national study of the impact of remote learning found that Florida avoided dramatic losses in learning during the 2020-21 school year.
— RIP: Laura Branker, a former Secretary at the Agency for Healthcare Administration in the Jeb Bush administration who later served as the health care director of corporate affairs for Walmart, has died of cancer.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
—“How a COVID-19 lockdown in China has led to South Florida hospitals rationing medical scans” via Daniel Chang of the Miami Herald — Some South Florida hospitals are rationing supplies of a contrast dye used for medical imaging, such as CT scans and MRIs, and prioritizing the drug for patients with emergencies or critical cases that require surgery, including heart attacks and strokes. No South Florida hospital has reported a disruption in inpatient care due to the global drug shortage, which should last another six to eight weeks. In April, a deficit in drug inventories occurred after a COVID-19 lockdown shut down a GE Healthcare plant in Shanghai that produces an essential ingredient for contrast dye.
—“Central Florida health care systems rethink nursing amid shortage” via Caroline Catherman of the Orlando Sentinel — HCA Florida Healthcare, AdventHealth Central Florida and Orlando Health are offering tuition reimbursement, signing bonuses, and opportunities for career growth to attract nurses from the limited pool of graduates. The hospital systems have expanded partnerships with nursing schools and added more clinical sites. But adding new nurses is only part of the solution, said Teri Moore, nurse operations manager of the critical care unit at Orlando Health Dr. P. Phillips Hospital in Southwest Orange County.
—“Primary-care doctors coming to a shopping center near you” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — Sanitas, in partnership with insurer Florida Blue, already has medical centers in shopping plazas in Boca Raton, West Palm, Palm Beach Gardens and Wellington. Anyone with Florida Blue can access the care, or those without insurance can purchase a primary-care membership. “We anticipate Lake Worth is going to be our largest location in the Palm Beach area and our first hub in the county,” said Dr. Venis Wilder, regional medical director for Sanitas Medical Center. “If patients have a need in any of our other sites, they can be directed here in order to take care of their preventive care needs, the completion of it.”
—“Hundreds of thousands of Florida residents may become uninsured in 2023 without premium tax credits,” via Veronica Zaragovia of WLRN — When you enroll in an Obamacare marketplace plan, you can have the credit paid to your insurance company to make that monthly plan cheaper. Or you can get a credit back when you file your tax return for the year. Research from the Urban Institute and the Robert Wood Johnson Foundation suggests that if Congress lets these credits expire, states with the largest losses would include Florida, Georgia, and Texas — states that did not expand Medicaid eligibility under the Affordable Care Act and that had considerable growth in enrollment for health plans on the Obamacare marketplace for 2022 with the enhanced PTCs.
—“Masks are unmasking what many people didn’t realize: They have hearing loss,” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — For Floridians of all ages, the last two years of the pandemic have been particularly difficult for hearing concerns. Researchers are still studying to what extent COVID-19 causes hearing loss, tinnitus, or balance problems and the long-term consequences of the virus. But precautions such as masks and social distancing have magnified hearing problems. Matthew Jones, a hearing instrument specialist with Beltone in Central Florida, says he has seen several patients whose hearing has worsened since the pandemic started.
— PENCIL IT IN —
May 15-22 is National EMS Week
Happy birthday, Sen. Kathleen Passidomo.
8 a.m. The Florida Board of Physical Therapy meets. DoubleTree by Hilton Hotel Tampa Airport-Westshore, 4500 West Cypress St., Tampa.
9 a.m. The Florida Board of Osteopathic Medicine meets Embassy Suites Lakes Buena Vista, 4955 Kyngs Heath Road, Kissimmee.
9 a.m. The Florida Board of Hearing Aid Specialists meets. Meeting link here. Or call 866-899-4679; participant code 620640133
5 p.m. Deadline for AHCA to post answers to questions regarding the Medicaid request for information.