Diagnosis For 4.11.22: Checking The Pulse Of Florida Health Care News And Policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

Gov. Ron DeSantis‘ administration is not giving up its push to protect physicians’ freedom of speech amid the COVID-19 pandemic. While lawmakers didn’t pass the so-called Free Speech of Health Care Practitioners Act, state Surgeon General Joseph Ladapo appeared before the Florida Board of Medicine Friday at its Tampa meeting and urged the panel not to discipline doctors for differences of medical opinions.

While legislators agreed to deliver on several of the Governor’s health care priorities, including increasing by $37 million annually the amount of cancer funding and ensuring patients and long-term care facilities residents have visitation rights, the Legislature did not pass legislation that would have made it more difficult for licensing boards to prosecute health care providers.

As state Surgeon General, Ladapo also serves as Secretary of the Florida Department of Health, which houses the state’s health care licensure boards.

Meanwhile, this past week, DeSantis signed dozens of bills, including ones involving the health care and nursing home industries. Most were signed a day after receiving them from the Legislature, including the measure to overhaul the contracting process used to select managed care plans for Florida’s Medicaid program and a bill that revised the staffing requirements for nursing homes.

The bill still has not gone officially to DeSantis’ desk. The anticipation is that it will probably wait until after the redistricting Special Session scheduled to start on April 19. In 2020, amid the ongoing disruption caused by the COVID-19 pandemic, state legislators approved the budget in March, but DeSantis did not act on it until June. Last year legislators approved the budget on April 30 and did not send it to the Governor until June 1.

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— Legal showdown —

State regulators want to alter the CON process to allow providers to note errors in underlying reports used to determine whether there is a “need” for new hospice programs. The administrative challenge by the Florida Hospice and Palliative Care Association and five hospice programs say, “this change is abrupt as it would reverse nearly 30 years of proceeding under the current rule” and “this proposed amendment would in effect allow erroneous determinations and leave impacted hospices no means for redress.”

The five initial hospice providers included Cornerstone Hospice & Palliative Care, which serves patients in seven Central Florida counties. A sixth hospice — AVOW Hospice — has joined the case as an intervenor. The Division of Administrative Hearings docket does not include from AHCA any filing that defends the rule change, although the groups challenging the rule state that “the only articulation of a reason for the proposed amendment has been a misplaced and unsupported belief that the challenged proposed amendment speculatively will avoid future administrative litigation.”

State regulators use the CON process to determine if there is a demonstrated reason to allow expansion in complex and costly medical programs. State legislators made significant revisions to Florida’s certificate of need process in 2019 and removed the requirement for hospitals and “tertiary” services. But the process remains intact for hospices.

In its rule challenge, attorneys for the hospice association and hospices contend the revisions proposed by AHCA are vague and inconsistent and exceed agency authority. But they also contend it “will result in unnecessary duplication of hospice services, a decrease in quality of care and health care resources available to hospice patients and an increase in expenses to provide hospice services.”

The filing states that AHCA could also use incorrect information to deny new hospice beds, which “would suppress need.”

— Courting the senior vote —

This past week, DeSantis signed a heavily lobbied bill that altered staffing requirements for Florida’s nursing homes which the nursing home industry contended was a much-needed change to deal with ongoing shortages at facilities around the state. The decision by the Governor was not a huge surprise since he had signaled his support of the legislation at the end of the regular session in March. But the measure was widely criticized by AARP’s Florida chapter, which called for a veto.

Rep. Charlie Crist was opposed to the bill, and he sharply criticized the Governor’s decision to back the changes. On Friday, the Democratic challenger to DeSantis tweeted: “it’s a bill that harms seniors in nursing homes and fails to address the staffing shortage. Our seniors deserve to be protected and treated with dignity. Instead, they’re being shortchanged by their Governor.”

Crist has made a pitch to seniors a big part of his campaign platform; he stressed it again during a visit to The Villages over the weekend.

But what’s also noteworthy in this year’s battle over nursing home standards is that the legislation resulted from an unusual alliance between the state’s nursing home industry and the Florida Justice Association, which represents trial attorneys in the state. Crist, who once worked for Morgan & Morgan law firm, has long relied on financial help from the state’s legal sector. His political committee, Friends of Charlie Crist, has more than 60 contributions where the listed occupation on campaign records is an attorney. For example, medical malpractice attorney Michael Trentalange donated more than $100,000 to his campaign last year. He also received large donations from attorneys who represented Florida in its landmark lawsuit against tobacco companies that resulted in a multibillion settlement.