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

— Medicaid changes —

Florida’s Medicaid managed-care system will undergo significant changes this month, including implementing new and streamlining the number of Medicaid regions in the state.

Under legislation approved in 2022, the state is trimming the number of Medicaid managed-care regions from 11 to nine, and the new areas will carry a letter identifier (A through I) rather than the previous system’s numbered naming scheme.

The regional shift impacts North Florida, where the old Regions 1 and 2 in the Panhandle combine into the new Region A, and the old North Central Florida-based Region 3 and the Jacksonville-anchored Region 4 merge into Region B.

The shift coincides with the implementation of new managed-care contracts awarded by the Agency for Health Care Administration last year after a lengthy procurement process.

The contracts were awarded to Aetna Better Health of Florida, Florida Community Care, Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare Plans, South Florida Community Care Network (d/b/a Community Care Plan), Sunshine State Health Plan, and United Healthcare of Florida.

The Medicaid managed-care system services more than 3 million of the approximately 4.4 million Florida Medicaid recipients.

— Butt surgery legislation —

Freshman Rep. Richard Gentry has filed a bill aimed at improving patient safety for in-office surgeries such as “Brazilian butt lifts” (BBL).

HB 309 mandates that medical offices undergo annual inspections by the Department of Health. Facilities must also meet registration requirements, including evaluations by the Joint Commission on Accreditation of Healthcare Organizations.

Other key provisions in the bill:

— In-person evaluations and supervision: BBL procedures would require in-person evaluations, written patient consent, and supervision by a licensed physician. All health care professionals must be licensed or certified and trained in advanced cardiac life support.

— Surgical timing and reporting: The bill permits office surgeries only during regular office hours. Any hospitalization must be reported within 48 hours.

— Operational restrictions: Surgeries cannot occur during structural renovations, and offices must maintain critical care equipment on-site.

— Oversight committee: The legislation establishes an oversight committee responsible for monitoring compliance and reporting any violations.

— Insurance requirements: Physicians performing these procedures must carry a minimum of $1 million in medical malpractice insurance or demonstrate financial responsibility.

The bill is named “Hillary’s Law” in memory of Hillary Brown, who died a week after experiencing a seizure and cardiac arrest suspected to be linked to lidocaine toxicity during a cosmetic procedure conducted by her husband, Dr. Ben Brown, at his practice, Restore Plastic Surgery, which has since closed. Reports indicate that Brown delayed calling 911, and the incident is currently under state investigation.

This new measure builds on a 2024 law designed to address gaps in regulations surrounding in-office surgeries and gluteal fat grafting procedures. The previous legislation (HB 1561) specified that all medical offices must register with the state if they remove fat from patients. It changed the fines for noncompliance from $5,000 per day to $5,000 per violation. The law also required physicians performing BBLs to hold professional liability insurance.

— Budget busting —

After Gov. Ron DeSantis announced his new budget proposal for Fiscal Year 2025-26, certain health services could be reduced, but others would receive a boost.

The Governor’s budget recommendations for Health and Human Services focus on behavioral health, cancer research, substance use issues, seniors and their caregivers, those with unique abilities and survivors of human trafficking.

However, while the proposed budget would boost funding for cancer research and other initiatives, some programs geared toward local community health initiatives could be affected.

The state allocated $4.28 billion for health care in the 2024 budget. This year’s budget recommendations include reducing health spending by $458 million to $3.8 billion and redirecting some funding from existing health care programs into new initiatives.

The Children’s Medical Services Program would get cut from a $399.6 million allocation in the current year’s budget to $211.5 million — a $188.1 million reduction in proposed funding.

The Community Public Health Program would see an overall $260.8 million cut from $3.47 billion to $3.21 billion. Services within the program, such as community health promotion, would be reduced by $478.6 million. Approximately $355.5 million would shift into Public Health Statistics and Innovation.

Funding for the local health needs of County Health Departments would be reduced from $1.23 billion to $1.22 billion, a $7.7 million difference, while the Disability Benefits Determination Program would see a $25.88 million cut, being pared down from $174.4 million in the current budget, to $148.6 million.

DeSantis’ “Focus on Fiscal Responsibility Budget” appropriates $115.6 billion, $3 billion lower 2024’s budget.

— Baptist Health —

One of Jacksonville’s largest hospitals is going to get substantially larger.

Baptist Medical Center Jacksonville and Wolfson Children’s Hospital will undergo a $190 million addition for the hospital grounds on the Southbank of downtown. When completed, the additional space will end with a new four-story tower, bringing 123,000 square feet more space.

The additions will bring more emergency room operations, waiting areas and patient care rooms. In all, there will be 100 emergency rooms in total. Some 63 ERs will be for adults and 37 for children. Three of the rooms will treat pediatric trauma on the first floor.

Work on the expansion begins this year, and its expected completion date will be in 2027.

“Our main campus provides care for more emergency patients than any other hospital in the greater Jacksonville area,” said Michael A. Mayo, president and CEO of Baptist Health. “We feel strongly, and our Board wholeheartedly agrees, that it is critical to ensure we not only provide the best quality of care but also make the experience the best it can be for our patients and caregivers alike. We challenged ourselves to do more than expand and renovate what exists today – instead, we are reimagining the entire environment of care.”

— Roster —

A new head and neck specialist joins HCA Florida Memorial Hospital in Jacksonville.

Russell B. Smith is the latest addition to the hospital’s dedicated care team. His expertise is in advanced surgical care for conditions in patients’ head and neck regions. His area of treatment is relatively broad, including treating cancers in the head and neck and associated areas such as the mouth, throat, voice box, sinonasal cavities, and skin, as well as other places.

“We understand that being diagnosed with cancer is life-changing. We are committed to taking a personalized approach to provide multidisciplinary care for each of our patients, making sure they understand all options to therapy,” said Smith. “At all times, our patient’s care and comfort is our highest priority, and our entire team works diligently to ensure that each patient and their entire family are supported throughout the process.”

Smith’s practice will be in the Head & Neck Specialists wing of HCA Memorial Hospital located at University and Beach Boulevards in Jacksonville.

— ICYMI —

“Ben Albritton prioritizes autism help, backs new bill” via Gabrielle Russon of Florida Politics — A new bill backed by Senate President Albritton would provide more support for parents who have children with autism and would expand existing free state services. Sen. Gayle Harrell filed SB 112, extending the Early Steps program availability until a child’s fourth birthday, from its current expiration at age three. It would also make other changes to help charter schools and summer camps designed for autistic students. The bill would also expand the health department’s program to include free autism screenings. Albritton called assisting people with autism a legislative priority.

“Keeping kids with disabilities safe: Kristen Arrington and Anna Eskamani file bill” via Gabrielle Russon of Florida Politics — Sen. Kristen Arrington and Rep. Anna Eskamani want the state to require schools to have a plan already in place if a student escapes during the school day. Eskamani called HB 345 and SB 460 “lifesaving.” Under their plan, every school district would be required to set up a staff assistance for emergencies (SAFE) team to take action. Every school’s principal, assistant principal, and at least five others picked by the principal would make up the SAFE team and be in charge of developing an annual “elopement plan.” The team would also train the rest of the staff how to do a search grid of school property, including “all bodies of water, intersections, train tracks and stations, parks, playgrounds, and other features that may present a greater risk for students with disabilities at risk of elopement.”

— Rules —

Rule 59G-4.125, regarding the administration of Florida Medicaid behavior analysis services to recipients, goes into effect Feb. 10. More here.

Rule 64B32-6.004, regarding procedures for approval of attendance at continuing education courses, goes into effect Feb. 13. More here.

Rule 64B7-25.001, regarding examination requirements for massage therapists, goes into effect Feb. 13. More here.

Rules 64B7-26.003, regarding massage establishment operations, goes into effect Feb. 13. More here.

Rule 64B5-2.0144, regarding licensure requirements for dental hygiene applicants from unaccredited dental schools or colleges, goes into effect Feb. 20. More here.

— Pencil it in —

Feb. 11

It’s “We Are TGH Day” in the Capitol, highlighting Tampa General Hospital’s status as a leading academic health system. On this advocacy day, patient advocates, loved ones, staff members, and others will travel to Tallahassee to speak with lawmakers about the lifesaving and innovative care they received at TGH. The day will also feature complimentary food trucks on Adams Street between 9 a.m. and 3 p.m.

8 a.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

1 p.m. — The House Health Professions & Programs Subcommittee meets. Room 102, House Office Building.

3:30 p.m. — The House Health & Human Services Committee meets. Room 17, House Office Building.

5:45 p.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

Feb. 12

10 a.m. — It’s “Behavioral Health Day” at the Capitol. The Florida Behavioral Health Association will host a press briefing at 10 a.m. at the Florida Historic Capitol Museum.

8 a.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

9 a.m. — The Social Services Estimating Conference meets to discuss KidCare caseloads. Room 117, Knott Building.

1 p.m. — The House Health Care Budget Subcommittee meets. Room 314, House Office Building.

3:30 p.m. — The House Health Care Facilities & Systems Subcommitteemeets. Room 404, House Office Building.

5:45 p.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

Feb. 13

8 a.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

9 a.m. — The House Human Services Subcommittee meets. Room 314, House Office Building.

9 a.m. — The Social Services Estimating Conference meets to discuss Medicaid caseloads. Room 117, Knott Building.

11 a.m. — The House Combined Workgroup on Vetoed Human Services Budget Issues meets. Room 404, House Office Building.

Feb. 18

Happy birthday to Reps. Doug Bankson, Johanna Lopez and Jenna Persons-Mulicka!

1:45 p.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.

Feb. 19

Happy birthday to Rep. Bill Conerly!

9:30 a.m. — The House Health Professions & Programs Subcommittee meets. Room 102, House Office Building.

1 p.m. — The House Health Care Budget Subcommittee meets. Room 314, House Office Building.

3:30 p.m. — The House Human Services Subcommittee meets. Room 314, House Office Building.

Feb. 20

Happy birthday to Rep. Joseph Casello.

1 p.m. — The House Health Care Facilities & Systems Subcommittee meets. Room 404, House Office Building.

Feb. 21

Happy birthday to Sen. Jay Trumbull!

Feb. 24

9:30 a.m. — The Social Services Estimating Conference meets to discuss KidCare expenditures. Room 117, Knott Building.

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Republican Reps. Vicki Lopez and Vanessa Oliver are pushing legislation to make it safer to enjoy Florida’s waterways.

The measure (HB 289) would strengthen penalties for those operating boats recklessly or under the influence. It would also require safety training for all boaters.

“For Floridians, boating is more than just a pastime — it’s a way of life. But with that privilege comes a serious responsibility,” Oliver said in a statement announcing the legislation. “Too many lives are lost each year due to preventable boating accidents, and it’s time for action.”

The legislation is being dubbed “Lucy’s Law,” named after 17-year-old Luciana Fernandez, who died during a September 2022 boat crash that left other passengers injured, including 18-year-old Katerina Puig, who is now permanently disabled.

George Pino is facing homicide charges after operating a boat, where Fernandez, Puig and others were on board, when it violently struck a channel marker. Puig refused a breathalyzer at the time.

“No parent should have to endure the pain of losing a child — especially in a preventable accident. Our family is living proof of what happens when our laws fail to keep up with the times,” read a statement from the Fernandez family.

“It is too late to save Lucy, but it is not too late to protect the next child and family from experiencing this same heartbreak. We are grateful to Representatives Oliver and Lopez for spearheading this effort, and we are honored this bill carries our Lucy’s name.”

The legislation would make accidents in which property damage is involved a first-degree misdemeanor, up from second degree. If someone is hurt, but it’s not a serious bodily injury, prosecutors can charge a third-degree felony. In the event of a serious bodily injury, it’s a second-degree felony, up from a third-degree felony. And accidents involving death would be punishable as first-degree felonies.

Additionally, if a person is found to be boating under the influence or operating recklessly, their license “shall be suspended until all orders of the court have been satisfied.”

Lawmakers say the upcoming Legislative Session is the time to make these changes.

“I am proud to sponsor Lucy’s law,” Lopez said. “This legislation strengthens training requirements to ensure that every boater has the knowledge and skills needed to navigate our waters safely. By making these simple but crucial changes, we can save lives like Lucy’s and protect the memories Floridians make on the water.”

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