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Florida's healthcare providers are stuck between federal and state COVID-19 rules

Stuck between a rock and a hard place - idiom
ann gadd
/
stock.adobe.com
In their package of bills designed to thwart COVID-19 mandates, Florida lawmakers may have put healthcare facilities between a proverbial rock and a hard place due to conflicting federal and state laws.

Florida lawmakers voted this week to clamp down on COVID-19 mandates from businesses and the federal government.

Hours before the Florida Legislature convened a special session Monday, doctors with the Committee to Protect Health Care held a media event via Zoom. They pleaded with the legislature to reject what they referred to as Gov. Ron DeSantis’ anti-health proposals.

"Gov. DeSantis’ COVID-19 response has led and will continue to lead to unnecessary and avoidable suffering and death," said Dr. Fred Southwick, an infectious disease specialist in Gainesville. "Vaccinations prevent the virus from spreading and mutating to become more resistant to vaccines. Vaccinations add to the number of people in the community who are protected from getting COVID-19. These are the facts.”

Republican leaders say their efforts are about freedom and saving jobs. The legislature voted to add a string of opt out provisions to any COVID-19 mandates in the public and private sector, which has created confusion and uncertainty for healthcare facilities that must abide by federal rules.

Specifically, a new rule issued by the federal Centers for Medicare & Medicaid Services (CMS) requires healthcare workers to be vaccinated. It allows only two exemptions - for medical or religious reasons. Healthcare providers that don’t comply could lose some of their federal Medicaid and Medicare funding.

"It has our members very concerned,” says LeadingAge Florida President and CEO Steve Bahmer. The association advocates for older adults and their care. Members include assisted living facilities and nursing homes.

"It's very challenging just in terms of the policy, the discrepancies, and the concern about potential enforcement that comes from those inconsistencies,” Bahmer says. He points out that federal law supersedes state law. Yet healthcare providers could face fines from the state if their workers follow the federal rule as required.

"The challenge is that CMS has some pretty dramatic enforcement power. They can deny payments; they can disenroll providers from the Medicare/Medicaid programs," Bahmer says. "We don't know what enforcement will look like or how serious that will get. But our members take the CMS enforcement power very seriously.”

Rep. Carlos Guillermo Smith, D-Orlando, also sees a problem. "Have you considered any sort of exemptions for our Medicaid and Medicare providers who are in a tough position here?"

That question was for Rep. Erin Grall, R-Vero Beach. She sponsored the bill cracking down on vaccine mandates. Guillermo Smith unsuccessfully tried to amend the bill to exclude healthcare providers from the additional exemptions. Grall said the amendment was unnecessary because she expects the CMS rule to be blocked by the courts.

“There are times when federal law will in fact preempt state law. But that will be worked out in a very swift fashion due to the extensive nature of these mandates," Grall said during discussion on the House floor. "So I'm certain that there will be clarity in the coming weeks before these mandates have to be fully implemented."

The special session ended Wednesday, and the governor signed the bills into law Thursday.

The CMS rule calls for healthcare workers to be fully vaccinated by January 4th. In response, Florida Attorney General Ashley Moody has filed a lawsuit. She's asking a judge to block the rule before December 6th, the day healthcare workers are required to have at least one dose.