Policy and politics were center-stage last week as the Legislature squeezed in two weeks worth of work in five days, so they will be able to participate in the Passover and Easter holidays.  Dozens of large policy issues involving tort reform, legal challenges to the federal health care bill, billion dollar budget issues, teacher tenure, school class size and reform of the Florida Public Service Commission were all big topics of discussion.  Hundreds of amendments were considered as committee meetings went into overtime in order to hear as many bills as possible.
 
This week the Legislature has an abbreviated schedule, meeting only on Wednesday and Thursday.  The Legislature will transition back into high gear following the Passover and Easter break.
 
            Following is the status of FAFP's priority issues:

- Senate and House budgets approved by Full Appropriations Councils
The Senate Full Appropriations Committee finalized its budget provisions, which establishes two medical home projects in Service Areas 1 and 2 (from Pensacola to Tallahassee regions).  The House Full Appropriations Council also approved its budget; however, at this time no decision has been made with regard to its Medicaid reform plan.  Last week the House Select Policy Council on Strategic and Economic Planning discussed state Medicaid program options, including medical home.  The House is expected to release its Medicaid reform plan in the next two weeks, which we expect to include some type of medical home language.

- HB 7183 amended and approved by Health Care Appropriations
HB 7183 by the House Health Care Regulation Committee aims to refocus the mission of the Department of Health (DOH) by streamlining and prioritizing public health functions in order to create greater efficiency and accountability while increasing the quality of care for Floridians.
 
The bill focuses DOH on seven core health care functions, including surveillance of communicable diseases, implementation of interventions that prevent or limit the spread of disease, preparedness functions related to public health emergencies, regulation of environmental activities impacting the state, administration of health and related services to target populations, collection and management of vital statistics data and regulation of health care practitioners. The bill also requires DOH to submit a new department structure that includes a reduction in the number of divisions, bureaus and executive positions. 

Last week an amended version of HB 7183 was approved by the House Health Care Appropriations Committee.  The Senate does not have a companion bill; however, this bill will certainly be part of the negotiations between the Senate and House.

The Senate and House health and human services budgets were approved by the full appropriations committees this week.  At the beginning of the budget process, the Senate and House were approximately $300 million apart in total health care spending, but nearly $1 billion apart in Medicaid spending with the House being more generous in both categories.
 
The Senate Policy Committee on Ways and Means adopted a revised budget this week that included the expected extension of federal matching assistance with Medicaid (FMAP).  Several major cuts were avoided with this move.  The Senate was previously opposed to making such a move as the federal government had yet to release the funds.  Senator JD Alexander (R-Lake Wales), the Senate's budget chairman, expressed strong confidence that with passage of the federal health care reform package, states will likely receive financial assistance by early April.
 
The total estimate of the fiscal impact of the new federal assistance is more than $800 million.  The Senate used the additional funds to eliminate reductions in payments to nursing homes and provide funding for the Medically Needy Program and Medicaid Aged and Disabled Program (Meds AD) through June 30, 2010.  The Senate removed the increased assessment on hospital inpatient and outpatient services ("sick tax"), which would have generated more than $50 million in additional funds for health care services.  However, the Senate still reduces hospital inpatient and outpatient rate payments by six percent as a major cost reduction measure. There were other programs affected by this infusion of dollars, including the restoration of Behavior Assistant Services Group Homes and their provider rate reductions were restored.  The Healthy Families Program was reinstated along with the Adult Mental Health Program.  
 
The House's Full Appropriations Council approved its budget last week, but did not make significant changes to its health and human services budget. 
 
The Senate and House budgets will receive a full vote by their respective chambers this week. Budget differences will be decided during the legislative budget conference process. 

- SB 2034 approved by Senate Judiciary last week
SB 2034 by Senator Steve Wise (R-Jacksonville) and HB 1529 by Representative Nick Thompson (R-Ft. Myers) place requirements on pre-dispute and post-dispute arbitration agreements used in medical negligence and nursing home cases.  The bills state that the provider may not refuse to provide services solely because the consumer refused to sign the agreement or exercised the right of rescission.  The bills also limit the use of arbitrations in emergency medical situations. 
 
            SB 2034 was approved by Senate Judiciary last week with two technical amendments.  The bill has three more committee hearings before a vote by the full Senate.  HB 1529 received three references, and has yet to receive a hearing.

- HB 5309 approved by House Full Appropriations Council
HB 5309 by the House Health Care Appropriations Committee makes numerous changes to the Statewide Tobacco Education and Use Prevention Program (Program).  HB 5309 is a budget conforming bill that was introduced late last week, and was unanimously approved by the Full Appropriations Council this week.  HB 5309updates terminology and changes statutory references from "smoking" to "tobacco use," and expands the Program's media campaign component to include innovative communication strategies. The bill provides $10 million for Area Health Education Centers (AHECs), subject to appropriation, and deletes language requiring the AHECs to compete for future funding. Additionally, the bill authorizes community mental health providers under contract with the Department of Children and Families to receive annual funding to provide intervention and tobacco use cessation treatment for persons with mental illness.   The Senate does not have a similar companion bill at this time, but this bill will be discussed as part of the budget conference negotiations.

- No Change
SB 2504 by Senator Al Lawson (D-Tallahassee) prohibits a licensed facility from employing a hospital-based physician or group of hospital-based physicians, or entering into a contract with such physicians unless those physicians are under contract with same health insurers as the licensed facility.  SB 2504 received three committee references, but has yet to receive a hearing.  The House does not have a companion bill.

- SB 2272 and SB 2722 approved by Senate Health Regulation
SB 2272 by Senator Mike Fasano (R-New Port Richey), 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. 
 
            HB 225 prohibits physicians from dispensing more than a seventy-two hour supply of controlled substances listed in Schedules II and III.  SB 2722 received its first committee hearing last week.  The bill was amended and unanimously approved by the Senate Health Regulation Committee.  Under the amendment, physicians must document a legitimate reason for dispensing more than a seventy-two hour prescription for a controlled substance in the patient's medical record.   A similar bill by Senator Fasano, SB 2272, was also approved last week.  The two Senate bills are expected to merge at the next committee hearing, and Senators Gardiner and Fasano will work out the differences.  Senator Fasano's bill does not include the seventy-two hour dispensing limitation for physicians.  Members of the Senate Health Regulation Committee received testimony from organized medicine and agreed that the seventy-two hour dispensing issue could impact legitimate physician prescribers and their patients.  The FAFP continues to work with colleagues at the Florida Medical Association to address organized medicine's concerns with the bills, and expect a sensible resolution.
 
            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.
 
            SB 2722 has two more committee hearings before a vote by the full Senate and HB 225 has one more committee hearing before a vote by the full House.    

- HB 1141 workshopped by House Roads, Bridges and Ports
Bills by Senator Victor Crist (R-Tampa) and Representative Kevin Ambler (R-Tampa) were inspired and written by a group of high school students from the legislators' 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.
 
            Last week HB 1141 was discussed in a workshop by the House Roads, Bridges and Ports Policy Committee.  The committee did not take a vote on the bill.  Student members of the "Ought to be a Law" program presented the bill and explained its importance to the health of children.  Several of the committee members voiced concerns that the bill infringes on a parent or guardian's right to decide what is in the best interest of their child, however the entire committee seemed very impressed with the presentation and the "Ought to be a Law" program. 
 
            SB 2596 received three committee references and HB 1141 received four committee references.  The bills have yet to receive a committee hearing.

- HB 107 amended and approved by House Health Care Regulation Policy
SB 214 by Senator Jeremy Ring (D-Margate) and HB 107 by 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.
 
            Last week HB 107 was amended and approved by the House Health Care Regulation Committee to match SB 214.  The bills now allow physicians the option to decide whether a referral is "medically necessary," rather than mandate that the physician refer a child to an "appropriate specialist" for screening for autism spectrum disorder.  If the physician does not believe screening a child is "medically necessary," the parent or legal guardian will be able to seek a second opinion from an "appropriate specialist" without obtaining a referral to that specialist.  The insurance lobby strongly opposes the direct referral provision.

            SB 214 has two more committee hearings before a vote by the full Senate. HB 107 has three more committee hearings before a vote by the full House.

- No Change
SB 330 by Senator Mike Bennett (R-Bradenton) and HB 135 by Representative Ron Reagan (R-Sarasota) allow optometrists to prescribe thirteen different oral medications, some of which are controlled substances.  SB 330 was 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.

- No Change
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.
 
            Senator Altman amended his bill to base the restraint requirement on a child's height rather than age. The bill has one more committee hearing before a vote by the full Senate.  HB 387 received three committee references.  The bill has yet to receive a hearing.

- No Change
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 quality care.         SB 516 received three committee references and HB 275 received four committee references.   The bills have yet to receive a committee hearing.

- No Change
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.  SB 1478 was supposed to receive a hearing by the Senate Banking and Insurance Committee this week, however the committee did not vote on the bill.  SB 1474 has three more committee hearings before a vote by the full Senate.   HB 791 received four committee references, and has yet to receive a committee hearing.

- No Change
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.  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.