The Florida Legislature convened the 2010 Legislative Session on March 2 with a projected $3 billion budget gap providing the overlay of the entire sixty-day session.  Governor Charlie Crist presented his fourth and final State of the State address to legislators on Tuesday evening and charged them to seek bi-partisan, common sense solutions as they grapple with the budget.
 
            State leaders are also actively seeking options for spurring job growth as the Florida economy continues to struggle.  On session's opening day, the Legislature voted to delay an increase in unemployment compensation taxes for two years, avoiding what would have been an enormous increase for Florida businesses.  Legislative leaders are also considering a proposal to reduce corporate income tax by one percent of the first million dollars in taxable income.  They are also focused on slicing state agency budgets to avoid seeking any new revenue increases, including efforts to reduce the size and scope of Florida's Department of Health (DOH).  This process will this week and continue through session's conclusion.
 
            On the political front, the legislative leadership of both legislative chambers promise steady leadership and more transparency in their deliberations, particularly in the budget arena.  The new level of transparency results from various ethics scandals within state government, one of which led to the resignation of former Speaker of the House Ray Sansom.
 
            Following is the status of FAFP's priority issues:

"Medical Home" is the buzzword in Tallahassee health care circles as legislators look for options to reduce Medicaid costs.  The term means different things to different people, but for the FAFP the Medical Home concept is the physician-led response to an alternative proposal to eliminate the MediPass system and to move the state's Medicaid patients entirely to a managed care/HMO model.  Representative Ed Homan, MD (R-Temple Terrace) intends to file a committee bill that creates medical home pilot projects throughout the state.  Senator Durrell Peaden (R-Crestview) recently filed SB 2532, his version. 
 
Also, the Senate Health Regulation Committee chaired by Senator Don Gaetz (R-Destin) and the House Health Care Appropriations Committee chaired by Representative Denise Grimsley (R-Sebring) have expressed interest in the medical home concept.
 
In the last several weeks, FAFP's leadership, Drs. Dennis Mayeaux, Dennis Saver, Bruce Flareau, and Coy Irvin, have analyzed various medical home options and worked with several like-minded organizations to present a united front.
On March 4, Dr. Coy Irvin, Chair of the FAFP Government Relations & Regulatory Policy Committee, presented a detailed proposal to the Senate Health Regulation Committee about a proposed business plan to implement a Medicaid medical home pilot project in several of Florida's panhandle counties.  FAFP continues to work with the House and Senate leaders on this important issue.

            The Florida Legislature held several budget workshops last week to review health and human services budgets and policies for next year.  Each committee received various health care agencies' proposed fifteen percent reduction proposals, as requested by the budget chairs.  The agency staff stated they did not endorse all of the measures but were trying to comply with the budget targets.
 
            For example, DOH's proposed reductions included elimination of more than twenty-five special projects that have traditionally been funded including, breast and cancer screening, HIV/AIDS care, dental health initiatives and diabetes programs.  The proposal also included reductions to Healthy Start programs and reimbursement rates to county health departments.
 
            The Agency for Health Care Administration (AHCA) proposed a total of $750 million in general revenue reductions.  The key cuts included savings produced by expansion of managed care (with the elimination of MediPass), decreasing hospital inpatient and outpatient rates, increasing the fee assessments on the major health care providers (hospitals, nursing homes, and HMOs), and the elimination of some optional Medicaid programs including dental, vision, and chiropractic care.
 
            At the end of last week, the House released its preliminary budget allocations for each service category. For health and human services, the House projects general revenue reductions of between $400-$500 million.  This reduction is based on a budget that does not include the extension of Medicaid financial assistance from the federal government after December 2010 (FMAP) but does add the recent $284 million that Florida received for Medicaid Part D assistance as a rebate for overpayments previously made.
 
            The current schedule for budget development will likely see both chambers wrap up their respective budget plans by the end of March.  During that time, legislators are likely to receive an update on the overall general revenue estimates, as well as some direction as to whether the U.S. Congress will provide Florida the estimated $1.01 billion in additional Medicaid assistance. 

            Senator Mike Bennett (R-Bradenton) and Representative Ron Reagan (R-Sarasota) filed bills allowing optometrists to prescribe thirteen different oral medications, some of which are controlled substances.  The optometry community has been very involved at the grassroots level with legislators and has solicited support from a few ophthalmologists who support the bills. 
            Two weeks ago, SB 330 by Senator Bennett was approved by the Senate Health Regulation Committee.  SB 330 has one more committee hearing before a vote by the full Senate.  HB 135 by Representative Reagan has yet to receive a committee hearing in the House.  FAFP is working with its partners at the Florida Medical Association and other specialty societies to oppose these bad bills. 
 
            Additional scope expansion bills were filed this year to increase the scope of physician assistants (PAs), advanced registered nurse practitioners (ARNPs) and physical therapists. SB 1456 by Senator Dennis Jones (R-Seminole) and HB 573 by Representative Paige Kreegel (R-Punta Gorda) delete the requirement that PAs provide evidence to DOH, before they prescribe or dispense medication, that they have completed three months of clinical experience practicing in the specialty area of their supervising physician.  HB 573 was unanimously approved by the House Health Care Regulation Policy Committee last week.  HB 573 has two more committee hearings before a vote by the full House.  SB 1456 received two committee references, but has yet to receive a hearing.  SB 188 by Senator Mike Bennett (R-Bradenton) and HB 677 by Representative Juan Zapata (R-Miami) include ARNPs to the list of practitioners authorized to prescribe controlled substances.  SB 188 received two committee references and HB 677 received three.  Neither bill has received a committee hearing.  SB 2146 by Senator Al Lawson expands the scope of a physical therapist and creates two new definitions for a physical therapy aide and a physical therapy assistant, both of whom would practice under a licensed physical therapist.  SB 2146 received two committee references, but has yet to receive a committee hearing.

            SB 2722 by Senator Andy Gardiner (R-Orlando) and HB 225 by Representatives John Legg (R-Port Richey) and Joseph Abruzzo (D-Wellington) further regulate the dispensing of controlled substances in Florida in an effort to curb prescription drug abuse.
 
            Currently, Florida law allows physicians registered with DOH to dispense any prescribed drug.  The bills prohibit physicians from dispensing more than a 72-hour supply of controlled substances listed in Schedules II and III.  The Senate bill also includes controlled substances under schedule IV.  Representatives Legg and Abruzzo recently removed schedule IV from the House bill.  Patients who receive prescriptions for controlled substances must fill them at pharmacies, rather than in physician offices or clinics.  The bills do not apply to controlled substance samples dispensed by licensed physicians. 
 
            The bills also prohibit DOH from registering pain clinics owned by non-physicians, pain clinics employing or contracting with a physician against whom regulatory action has been taken related to drug or alcohol abuse, and pain clinics with owners who have certain felony drug convictions.  Additionally, the bills require pharmacies to participate in a multi-state electronic prescribing network to transmit dispensing information for controlled substances through the network.
            HB 225 was approved by the House Health Care Regulation Policy Committee last week with two no votes.  One of the no votes was by Rep. Ron Renuart (R-Ponte Vedra Beach), an osteopathic physician.  Representative Renuart proposed a late-filed amendment during the committee meeting to remove the 72-hour limit on physician dispensing, but it would prohibit patients from using cash or a credit card to pay for controlled substances.  The amendment's intent was to try and differentiate between cash buyers and legitimate patients, whose care is more likely covered by insurance. Representative Renuart ultimately withdrew his amendment and agreed to work with Representative Legg to address his concerns with the bill.  However, Representative Renuart mentioned he will not support the bill as long as it includes the 72-hour limit on dispensing.   The Florida Medical Association (FMA) argued that many physicians, such as oncologists and orthopedic surgeons, legitimately dispense controlled substances in their offices, sparing patients a separate trip to the pharmacy.  Senator Gardiner has promised to work with the organized medicine to address our concerns with the Senate bill. 
 
            HB 225 has one more committee hearing before it receives a vote by the full House.  SB 2722 has yet to receive committee references.

           
            SB 516 by Senator Mike Fasano (R-New Port Richey) and HB 275 by Representative Denise Grimsley (R-Sebring) prohibit health insurance policies or medical service plan contracts from limiting, reducing or denying coverage for prescription drugs if the insured person is currently using the drug, if the insured person is covered under their policy/contract, or if the prescription drug was covered under the policy or contract.  These bills aim to promote patient safety and ensure continuity of care.
 
            SB 516 received three committee references and HB 275 received four committee references.  Neither bill has received a committee hearing.  FAFP is working hard to get these bills placed on committee agendas.

           
           SB 222 by Senator Jeremy Ring (D-Margate) and HB 117 by Representative Kevin Ambler (R-Tampa) require health care practitioners to provide the U.S. Centers for Disease Control and Prevention Vaccination Information Statement (VIS) to the parent or legal guardian of the minor before the minor receives a vaccination.  The bills require the parent or legal guardian to sign a statement acknowledging receipt of the VIS prior to the minor receiving a vaccination. This statement must be retained in the minor's permanent medical record, along with the batch and lot number of the vaccine that was administered.
 
            FAFP has been working with its colleagues at the Florida Pediatric Society, the FMA, Florida Osteopathic Medical Association (FOMA) and numerous public health advocates to educate legislators about the importance of vaccination and the impact on public health. 
 
            Two weeks ago HB 117 received a hearing by the House Health Regulation Policy Committee.  After public testimony from organized medicine and other opponents to the bill, Representative Ambler requested that the committee temporarily postpone the bill.  Last week Representative Ambler withdrew HB 117 from further consideration.    SB 222 has received three committee references.  The bill has yet to receive a committee hearing.  Without a companion bill in the House, it will be difficult for SB 222 to pass.

    
            Bills by Senator Jeremy Ring (D-Margate and Representative Marti Coley (R-Marianna) require physicians to refer children to an "appropriate specialist" for screening for autism spectrum disorder if a child's parent or legal guardian believes that child exhibits symptoms of autism. Under the bills, insurers are required to provide direct access to specialists for autism spectrum disorder screening if the screening is requested.
 
            SB 214 will receive its first committee hearing in the Senate Health Regulation Committee on Tuesday, March 9.  After Tuesday's hearing, SB 214 will receive two more committee hearings before a vote by the full Senate.  HB 107 has received four committee references.  The bill has yet to receive a hearing.        

            
Bills filed by Senator Charlie Dean (R-Inverness) and Representative Juan-Carlos Planas (R-Miami) provide substantive and technical changes to Florida's Comprehensive Statewide Tobacco Education and Use Prevention Program (Program). 
 
The bills require additional efforts to educate youth and their parents about the harms of tobacco use.  However, the bills delete the requirement, found in s. 27, Art. X of the State Constitution, that at least one-third of the Program's annual funding go towards a tobacco cessation counter marketing and advertising campaign.  The bills authorize that the State Surgeon General, or his or her designee, serve on the Statewide Tobacco Education and Use Prevention Advisory Council.  The bills also make several technical changes to the Program's operations, including how the Program may use its grant funding.  Finally, the bills increase funding for Florida's Area Health Education Centers (AHECs) from $10 million to $11 million for the 2010/2011 fiscal year. 
 
SB 2744 has yet to receive committee references. HB 1023 received three committee references, but has not received a committee hearing. 

          
            SB 1474 by Senator John Thrasher (R-Jacksonville) and HB 791 by Representative Ron Renuart (R-Ponte Vedra Beach) extend sovereign immunity to emergency health care providers who provide emergency care in hospitals.  The bills also include pre-hospital treatment or transport for emergency medical conditions that are not already covered under current sovereign immunity provisions.  Emergency health care providers are designated as agents of the state for purposes of s. 768.28, F.S. related to the waiver of sovereign immunity. 
 
            SB 1478 was approved on March 4 by the Senate Health Regulation Committee.  The bill will receive three more committee hearings before a vote by the full Senate.     HB 791 received four committee references.  The bill has yet to receive a committee hearing.

        
             Bills by Senator Victor Crist (R-Tampa) and Representative Kevin Ambler (R-Tampa) were inspired and written by a group of high school students in their districts through the, "Ought to be a Law" program.  SB 2596 and HB 1141 create a second degree offense for a person who is smoking while driving or in control of a motor vehicle when a minor under the age of sixteen is in the vehicle, regardless of whether vehicle is in operation or is parked.  If found in violation of the secondary offense, law enforcement may either issue a warning, or assess a $100 noncriminal moving or nonmoving violation in addition to issuing a penalty for the primary offense.
 
            HB 1141 was received four committee references.  SB 2596 has yet to receive committee references.

     
            SB 316 by Senator Thad Altman (R-Melbourne) and HB 387 by Representative Rich Glorioso (R-Plant City) revise child restraint requirements for children who are passengers in motor vehicles. Children ages four through seven must be transported in a separate carrier, integrated child seat or booster seat that is appropriate for the height and weight of the child.  If found in violation, law enforcement can assess a moving violation punishable by a fine of $60 plus court costs, and issue three points against the driver's license.
 
            SB 316 was unanimously approved by the Senate Transportation Committee two weeks ago and will be heard by the Senate Criminal Justice Committee on Tuesday, March 9. HB 387 received three committee references.  The bill has yet to receive a hearing.
 
 
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We hope this brief legislative update is helpful. We will keep you posted on these and other developments as the 2010 Session progresses.