Diagnosis for 8.29.22: Checking The Pulse Of Florida Health Care News And Policy

Florida has led the nation in the number of people enrolled in the federal health care exchange through the arduous work of Florida Covering Kids & Families at the University of South Florida (USF) College of Public Health.

Headed by Jodi Ray, Florida Covering Kids & Families has partnered with organizations from across the state to provide navigator services and collectively operates under the Covering Florida moniker.

For years it has been the only navigator program in the state to receive money from the federal government. And Friday, the Biden administration announced it would earmark $12,908,382 to USF and Florida Covering Kids & Families for navigator services across the state.

But the Biden administration also awarded $2,624,933 to the Urban League of Broward County (ULBC). According to the federal government website, the ULBC will provide navigator services beyond South Florida because it will partner with the Tallahassee Urban League, the Pinellas County Urban League, and the Urban League of Palm Beach County.

Through those partnerships the Urban League of Broward County will be able to supply navigation services to people living in Tallahassee, St. Petersburg, Clearwater, Palm Harbor, Tarpon Springs, Delray Beach, Lake Worth, Jupiter, and other cities in the three counties outside of Broward.

The money is to cover the costs of navigation services between Aug. 27, 2022, and Aug. 26, 2023.

In all, the Biden administration last week awarded $98.9 million in navigator grant awards to 59 organizations in 30 states that rely on the federal health insurance marketplace for access to subsidized health insurance policies, commonly referred to as Obamacare plans.

Open enrollment for the 2023 plan year begins Nov. 1, 2022.

I welcome your feedback, questions, and especially your tips. You can email me at SextonHealthNewsletter@gmail.com or call me at 850-251-2317.

— Broward Health saga —

A Broward Health Commissioner is seeking guidance from the state’s Ethics Commission amid the fallout of the death of his father-in-law.

Ray Berry, the Health Business Solutions CEO first appointed to the public board that oversees North Broward County’s five-hospital system by then-Gov. Rick Scott, asked for an advisory opinion in late June after conflict-of-interest accusations from a company that claims Berry’s firsthand experiences could cause it to lose a lucrative contract.

In a letter to the Commission, Berry explained that his father-in-law suffered from multiple myeloma and that he was initially treated at a hospital run by Memorial Healthcare System, which is the public health system for South Broward County but was transferred to a Broward Health-operated facility.

Berry contends that his father-in-law died in 2019 in part of an inability of the two public hospital systems to exchange electronic health care records.

Berry said he made a promise not to sue the district over his father-in-law’s death if “proper procedures were implemented” and that “something like this never happens again” although attorneys for Broward Health acknowledge nothing was ever put in writing.

“I was distraught after my father-in-law’s death, both because a wonderful man was lost, but also because in my opinion, the district, where I serve as Commissioner, was partly responsible,” Berry wrote.

After Berry’s father-in-law died, Broward Health began looking at its electronic health record databases and whether it should replace its current vendor, Cerner, and possibly turn to the database provider used by the Memorial Healthcare System. It’s a process that is apparently still underway.

But attorneys for Cerner have raised questions about Berry’s role and whether his involvement has “tainted” the process and cited many times that Berry raised questions about Cerner.

In mid-May, an attorney with the Kutak Rock law firm sent a lengthy letter to Broward Health’s general counsel that contended Berry had used his public position on the board “to secure a special privilege and benefit for himself and his family.”

It said Berry was using his “personal situation” to “influence the situation” of the Broward Health board.

“Commissioner Berry’s unwillingness to recuse himself, and the failure of the board to demand his recusal, has created a serious litigation threat and any decision made at this point would likely be set aside by a court,” says the letter signed by attorney Diane Carter.

The staff for Florida Commission on Ethics, however, reviewed the situation and said there is no conflict on the two main questions asked by Berry, noting that he has no financial or contractual relationship with any of the electronic health database vendors.

The Commission staff did say it could not render an opinion on some of Berry’s other questions, including whether it’s a misuse of his position to speak out because it requires more information to determine someone’s intent.

“In addition, we do not typically provide guidance in response to entirely hypothetical inquiries where the facts giving rise to the potential ethical issue are not provided with particularity to the inquiry,” says the staff.

The entire complicated saga will be hashed out in front of the Commission itself at its Sept. 9 meeting. Commissioners could vote to issue the recommended advisory opinion or reach another conclusion.

— MMJ caps are here —

The Office of Medical Marijuana Use issued an emergency rule that, for the first time, places caps on the daily dosage amount of tetrahydrocannabinol included in edibles, vaporization pens, creams, suppositories, and pills that can be ordered and bought by qualified patients every 70 days.

Posted on its website Friday and published in the Florida Administrative Weekly Monday, the emergency rule caps at 24,500 milligrams the amount of THC a patient can be prescribed for edibles, vaporization pens, creams, suppositories, and pills. The emergency rule also reiterates the statutory limit of 2.5 ounces of smokable medical marijuana for qualified patients every 70 days.

Some lobbyists say implementing the 24,500-milligram dosage limits could prove problematic because the aggregate limits take effect when patients renew their licenses or when their physicians amend their pre-existing orders.

But the 70-day look-back period, which affects all certified patients, kicks in at once. That means, sources say, there will be different rules for different patients until the 745,259 certified patients have their licenses renewed.

The emergency rule allows qualified physicians who order medical marijuana for their patients, whether smokable or one of the other routes of administration, the ability to request an exception and includes the request for exception form.

Medical marijuana lobbyists say the request for an exception is a possible upside to the emergency rule because while the 2017 law authorized exceptions to the 2.5-ounce cap on smokable marijuana, there hasn’t been a process for physicians to follow until now.

The caps come as the state’s medical marijuana market continues to grow. As of Aug. 25, there were 745,259 people registered in the state to use medical marijuana in Florida and 22 licensed “medical marijuana treatment centers.”

The MMTCs are the only entities authorized to cultivate, process, and dispense low-THC cannabis and medical marijuana. Each MMTC is required to have a medical director.

Gov. Ron DeSantis denied to the press last week having direct involvement in conversations about the caps.

The move to place caps on the amount of THC comes as the state prepares to approve new MMTCs. Unsolicited, however, DeSantis offered his opinion that the state should increase the costs of the MMTCs licenses.

“We should charge these people an arm and a leg. I mean everybody wants these licenses. Why wouldn’t we take the opportunity to make money for the state based on those,” the governor said.

The governor said that would require a statutory change, though.

Meanwhile, this is the second emergency rule the OMMU has issued in the last 30 days. The office issued an emergency rule saying that medical marijuana treatment centers can only maintain one department-approved website and that centers cannot offer website purchasing services without first obtaining approval from the state.

The emergency rule defines website buying as the “purchasing of or making reservations or pre-reservations for the purchasing of usable product or marijuana delivery devices” through a medical marijuana treatment center.

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