The Florida Legislature has only one issue it must address each year.  It must pass a budget.  Legislative leaders are taking that responsibility very seriously.  Week two of the 2010 Legislative Session moved at a breakneck pace as both policy and budget issues developed on parallel tracks.  The appropriations process started late last week, well ahead of the traditional schedule.  Moreover, legislative leaders have promised much broader transparency in legislative deliberations involving the budget.  Politically, they have little good news on the budget front and, like ripping off a band aid; they want to get the pain over with as quickly as possible.

      The Senate Health and Human Services Appropriations (HHS) Committee released its preliminary budget last Thursday.  Senate budget proviso includes a new provision that directs the Agency for Health Care Administration (AHCA) to establish at least two medical home projects on a capitated basis. One medical home would be established in the northwest Florida region, but must include Escambia County.  AHCA would be allowed to select one other region.   Finally, the medical home pilots may be administered by a hospital owned health plan called a provider sponsored network (PSN) or a health maintenance organization (HMO).  
    The House Health Care Appropriations Committee has yet to release its preliminary budget.  We are working with the committee to ensure that the proposal includes a medical home pilot project.

     The Senate's health care budget allocation is just over $26.67 billion with the AHCA's budget making up the bulk of that figure at $19.308 billion.  It is important to note this budget was based on Florida not receiving any extension of federal assistance for Medicaid from Congress (FMAP).  
      Senate budget reductions include rate reductions and price level decreases for hospitals, HMOs, nursing homes, the Healthy Kids program and prescription drugs.  The Medically Needy program and the MEDS AD program would be continued for another year, but would expire at the end of 2011.  Total reductions for institutional providers and prescription drugs alone within AHCA's budget amount to more than $329 million.  
      One of the key measures offered by the Senate would require many Medicaid patients to enroll in a managed care plan as a result of the MediPass program being phased out.  The proposal is estimated to generate $30 million in savings with these new patients entering a managed care plan which could be a HMO or PSN. The MediPass option would be eliminated in nineteen counties where patients can choose between two or more managed care plans.  Ultimately, the managed care requirement is expected to expand to counties where there are less than two plans available.  This proposal is expected to be discussed during committee hearings again next week.  A final vote is anticipated on March 19.
      Finally, the Senate HHS Committee on Thursday sent a letter to Senate President Jeff Atwater asking that any additional Medicaid funds that become available from the federal government be kept in the so called "life and death" committee. Committee members are concerned that the Senate would use extra federal money to supplant existing state money. The letter, signed by only three committee members (Sens. Peaden, Rich, and Sobel; Sens. Gaetz, Haridopolos and Negron declined), came out a day after the U.S. Senate passed legislation (similar to legislation already passed by the U.S. House) to give states, like Florida, a six-month extension on higher matching rates for Medicaid that would last through July 2011.    

      Bills by Senator Mike Bennett (R-Bradenton) and Representative Ron Reagan (R-Sarasota) allow 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.  
        SB 330 by Senator Bennett was recently approved by the Senate Health Regulation Committee, and 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 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 references.  The bills have yet to receive 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 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. 

     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. 
     HB 117 was withdrawn from further consideration after public testimony from organized medicine and other opponents to the bill.  SB 222 received three committee references, but has yet to receive a committee hearing.  Without a companion bill in the House, it is unlikely SB 222 will pass.           

     The Senate's preliminary budget proposal includes approximately $61.3 million for the Comprehensive Statewide Tobacco Education and Use Prevention Program.  The program's funding is adjusted each year for inflation using the consumer price index; therefore, the total amount of funding is slightly less than last year.  Fifteen percent of Tobacco Trust Fund interest payments go to fund this program, and one-third of total annual funding is used for educational and counter-marketing mass media, as mandated by section 27, Article X of the State Constitution.
     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 were filed without direction from the Department of Health (DOH), although DOH has not voiced opposition to the bills at this time.
     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 and HB 1023 each received three committee references.  The bills have yet to receive 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 recently approved 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.

     SB 2596 received three committee references and HB 1141 received four references.  The bills have yet to receive a committee hearing.