The Legislature concluded week seven of nine steeped in politics.  Governor Charlie Crist's veto of SB 6, the Legislature's education initiative, drew criticism from Republican legislators, several of whom withdrew their support for the Governor's senatorial campaign.  The media fueled the fire by increasing speculation that Governor Crist would leave the Republican Party and run for the U.S. Senate as an independent candidate. 
 
           Also, potentially bleak budget news from Washington D.C. generated questions about whether the additional federal dollars that legislative leaders are counting on to balance the state budget will be authorized. The budget conference process was to commence over the weekend, but was stalled indefinitely.       

          Two weeks ago the House Select Policy Council on Strategic and Economic Planning unveiled its Medicaid reform proposal.  The proposal (HB 7223) quickly moved through the committee process and was heard by the full House late Friday. The proposal ends MediPass and fee for service in Medicaid, and replaces those programs with the Managed Medical Assistance Program. Under the new program, a vast majority of Medicaid patients will be placed in a managed care plan. Only a small, select group of Medicaid patients will be exempt from mandatory managed care enrollment.  All care in the Managed Medical Assistance Program will be provided by a "qualified plan." Qualified plans are limited to health insurance companies, exclusive provider organizations, health maintenance organizations and provider service networks.  Qualified plans will be paid on a capitated, per-member per-month basis.  Additionally the proposal allows qualified plans to be designated as medical homes. The plans that choose to become an accredited medical home will receive priority in the plan selection process for a particular region. 
 
           Several amendments were adopted on the House floor, including a requirement that qualified plans must follow prompt payment guidelines that require qualified plans to pay a claim within twenty days of the receipt or notify the provider that the claim is denied. Ultimately if the qualified plan has not denied the claim within one hundred and twenty days, the claim must be paid in full. The House approved amendments easing concerns held by county taxing districts that contribute intergovernmental transfers for hospitals and also agreed to require qualified plans to develop internal grievance resolution procedures to respond to enrollees' grievances. 

- SB 2272 amended and approved by Senate Criminal Justice
         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. 
 
           Last week the content of SB 2722 was merged into SB 2272 during a committee hearing by the Senate Criminal Justice Committee.  SB 2272 by Senator Fasano received approval by the Senate Criminal Justice Committee. The new bill does not include the seventy-two hour dispensing prohibition for physicians, which was adamantly opposed by organized medicine. Several weeks ago during a committee hearing by the House Health Care Appropriations Committee, the seventy-two hour dispensing prohibition for physicians was removed from HB 225.
 
           SB 2272 has two more committee hearings before a vote by the full Senate.       HB 225 is awaiting a vote by the full House.    

- No movement
         SB 214 by Senator Jeremy Ring (D-Margate) and HB 107 by Representative Marti Coley (R-Marianna) allow physicians to decide whether it is "medically necessary" to refer a minor patient to an "appropriate specialist" for screening for autism spectrum disorder.  If the physician does not believe a screening is "medically necessary," the parent or legal guardian is permitted under the bill to seek a second opinion from an "appropriate specialist" without obtaining a referral to see the "appropriate specialist."  Insurers are required to provide direct access to an "appropriate specialist" for autism spectrum disorder screening if the screening is requested.  The insurance lobby strongly opposes the direct referral provision. 
 
           Representative Coley recently attempted to amend HB 107 to expand the definition of "appropriate specialists" to include individuals licensed under Chapter 491, clinical social workers, marriage and family therapists and mental health counselors. Representative Coley ultimately withdrew the amendment amid concerns expressed by organized medicine. Last week we met with Senator Ring on behalf of FAFP and urged him not to file the amendment to SB 214. Senator Ring does not appear interested in pursuing the amendment due to the public health concern we addressed during the meeting. The bills have one more committee hearing each before the bills receive votes by the full Senate and House.

- SB 896 by Senate Education Pre-K 12 Appropriations will receive a hearing today
          SB 896 by Senator Durell Peaden (R-Crestview) and HB 747 by Representative Nick Thompson (R-Fort Myers) prohibit a school district from restricting the assignment of a student who has diabetes to a particular school. 
 
           HB 747 was recently amended and the bills are now substantively different. Specifically, HB 747 prohibits school districts from restricting the assignment of a student who has diabetes to a particular school on the basis that the student has diabetes, that the school does not have a full-time nurse or that the school does not have trained diabetes personnel. The bill permits diabetic students, whose parent and physician provide their written authorization to the school principal, to carry diabetic supplies and equipment while in school or while participating in school sponsored activities. The State Board of Education, in cooperation with the Department of Health (DOH), must adopt rules for the management and care of diabetes by students in schools.  Additionally, FAFP worked with Representative Thompson to include a member of FAFP to the Diabetes Advisory Council.  
 
           HB 747 was approved by the full House last week and is awaiting consideration by the full Senate. SB 896 will receive its final committee hearing by the Senate Education Pre-K 12 Appropriations Committee today. During the meeting Senator Peaden is expected to amend his bill and make it identical to HB 747.

- HB 1503 amended and approved by the House Health and Family Services Policy Council
            SB 1256 by Senator Durell Peaden (R-Crestview) modifies the section of law that establishes DOH's responsibility for physician workforce development. SB 1256 creates a Physician Workforce Advisory Council and a Physician Workforce Graduate Medical Education (GME) Innovation Pilot Projects program. The bill repeals the Community Hospital Education Act that includes the Community Hospital Education Council, the GME Committee, the GME annual report and the Community Hospital Education Program.  Additionally the bill allows FAFP to recommend one of its members to serve on the Physician Workforce Advisory Council. SB 1256 has one more committee hearing before a vote by the full Senate. A similar bill, HB 935, by Representative Ed Homan (R-Temple Terrace) has yet to receive a committee hearing.
 
           Last week HB 1503, a comprehensive health care bill by Representative Anitere Flores (R-Miami) was amended to include the substance of SB 1256 and was approved by the House Health and Family Services Policy Council.

- SB 316 approved by Senate Transportation and Economic Development Appropriations
          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.  SB 316 bases the restraint requirement on a child's height rather than age. SB 316 received unanimous approval by the Senate Transportation and Economic Development Appropriations Committee last week. The bill is awaiting a vote by the full Senate. HB 387 received three committee references, and has yet to receive a hearing.

- HB 7183 is on the House Special Order Calendar for April 20
          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.  Specifically, HB 7183 authorizes the Department of Health (DOH) to develop a new plan for the treatment and hospitalization of patients with tuberculosis. Under the plan, DOH would close A.G. Holley State Hospital, and transition its patients to private and non-state public hospitals within a ninety day period. HB 7183 will receive a hearing by the full House this week.  The Senate does not have a companion bill. This bill will certainly be part of negotiations between the Senate and House during the final weeks.

-SB 2596 by Senator Victor Crist (R-Tampa) and HB 1141 by Representative Kevin Ambler (R-Tampa)

Statewide Tobacco Education and Use Prevention Program
- HB 5309 House Health Care Appropriations Committee
 
Balanced Billing
- SB 2504 by Senator Al Lawson (D-Tallahassee)
 
Arbitration Agreements Governing Certain Medical Negligence Claims
- SB 2034 by Senator Steve Wise (R-Jacksonville) & HB 1529 by Representative Nick Thompson (R-Ft. Myers)
 
Optometry/Oral and Topical Pharmaceutical Agents
- SB 330 by Senator Mike Bennett (R-Bradenton) and HB 135 by Representative Ron Reagan (R-Sarasota)
 
Physician Assistants
- SB 1456 by Senator Dennis Jones (R-Seminole) and HB 573 by Representative Paige Kreegel (R-Punta Gorda)
 
Advanced Registered Nurse Practitioners
- SB 188 by Senator Mike Bennett (R-Bradenton) and HB 677 by Representative Juan Zapata (R-Miami)
 
Continuity of Care
- SB 516 by Senator Mike Fasano (R-New Port Richey) and HB 275 by Representative Denise Grimsley (R-Sebring)
 
Sovereign Immunity for Health Providers
- SB 1474 by Senator John Thrasher (R-Jacksonville) and HB 791 by Representative Ron Renuart (R-Ponte Vedra Beach)