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2010
Florida Legislative Session
The 2010 Regular Session of the Florida
Legislature concluded Friday, April 30th after
legislators adopted a $70.4 billion dollar
budget. The session ended anti-climatically
with very little ceremony and no sign of Governor
Charlie Crist. In the waning days it was
uncertain if the session would end on time or if
the session might be extended in order to spend
more time on budget-related issues. Being an
election year, calmer minds prevailed, agreements
were sealed and the session concluded around 9
p.m. The Legislature passed a total of 301
bills, joint resolutions and memorials. This
number is a record low, as approximately 3,000
bills are filed each year. Obviously, Governor
Crist's political announcement dominated the
political headlines through most of the final week
of the
session.
Even before the session ended, rumors spread about
Governor Crist's new "independence" and the
potential that he would call the Legislature back
for a Special Session on the recently-adopted
budget, as well as a host of other issues.
At a minimum, many speculate that the Governor
will wield his veto pen to strike down
legislator's pet projects ("turkeys") and various
budget cuts to health care services. In a
sign of a more combative relationship with the
Governor, legislators sent Governor Crist 63 bills
on the session's final day that he must act on by
May 15th. For now, however, session is
over...and campaign season begins!
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Controlled
Substances
- SB 2272/HB 225
PASSED
SB 2272 by Senators Mike Fasano (R-New Port
Richey) and Andy Gardiner (R-Orlando) and HB 225
by Representatives John Legg (R-Port Richey) and
Joseph Abruzzo (D-Wellington) further regulate
pain management clinics and the dispensing of
controlled substances in Florida in an effort to
curb prescription drug abuse. The bills
require pain management clinics, as part of their
registration with the Department of Health (DOH),
to designate a physician licensed under chapter
458 or chapter 459 to comply with the requirements
of registration and the operation of the pain
management clinic. Physicians may not
practice medicine in a pain management clinic
unless the clinic is registered with DOH and the
physician has successfully completed an accredited
pain management fellowship or complies with rules
adopted by the Board of Medicine or the Board of
Osteopathic Medicine prior to July 1, 2012.
Under the bill, physicians must perform a physical
evaluation of the patient on the same day as he or
she prescribes and/or dispenses a controlled
substance to the patient in a pain management
clinic. If the physician dispenses more than
a seventy-two hour supply of a controlled
substance, the physician must report in the
patient's record the reason for prescribing and/or
dispensing that particular quantity.
Patients visiting pain management clinics are
prohibited from purchasing more than a seventy-two
hour supply of a controlled substance with cash,
check or credit card, unless they are paying an
insurance
co-payment.
DOH will institute a rule that defines the role of
the designated physician at a pain management
clinic and the Board of Medicine and the Board of
Osteopathic Medicine will adopt rules establishing
the number of schedule II or schedule III
controlled substances, or the controlled substance
Alprazolam, which may be written at each
registered pain management clinic. The Board
of Medicine and the Board of Osteopathic Medicine
will also adopt rules for physicians who practice
at privately owned pain management clinics who
primarily engage in the treatment of pain by
prescribing and/or dispensing controlled
substances. DOH may impose a fine of
$5,000 per violation if the clinic does not comply
with the requirements. SB 2272 awaits
approval by the
Governor.
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Treatment
of Diabetes
- SB
896/HB 747 PASSED
SB 896 by Senator Durell Peaden (R-Crestview) and
HB 747 by Representative Nick Thompson (R-Fort
Myers) prohibit 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 bills permit
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 DOH, must adopt
rules for the management and care of diabetes by
students in schools. The bills add a member
of FAFP to the Diabetes Advisory Council. HB
747 has been approved by the
Governor.
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Department
of Health (DOH)
- HB
5311 PASSED
HB 5311 makes several
revisions to statutes relating to trust funds
administered by DOH to conform to the General
Appropriations Act (GAA) for Fiscal Year
2010-2011. HB 5311 transfers the regulation
of drugs, devices, cosmetics and household
products from DOH to the Department of Business
and Professional Regulation (DBPR). The bill
creates the Physician Workforce Advisory Council
within DOH, and adds a member of FAFP to the
Council. The Council is directed to monitor and
provide recommendations on a variety of physician
workforce issues including the physician workforce
survey, the need for more primary care physicians
and specialists and the status of the state's
Graduate Medical Education Program. HB 5311
awaits approval by the
Governor.
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Statewide
Tobacco Education and Use Prevention Program
- HB 5309 PASSED
HB
5309updates terminology and changes statutory
references from "smoking" to "tobacco use" to
ensure the Program covers cessation for all types
of tobacco products. The bill expands the
Program's media campaign component to include
innovative communication strategies that
incorporate the use of personal communication
devices and online networking. 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. The bill maintains dollars for
community partnerships and does not divert funds
for a specific campaign focused solely on
cessation for individuals with mental
illness. HB 5309 awaits approval by the
Governor.
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Physician
Assistants
- SB 1456/HB 573
PASSED
SB 1456 by Senator Dennis Jones (R-Seminole) and
HB 573 by Representative Paige Kreegel (R-Punta
Gorda) delete the requirement that physician
assistants 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 573has been
approved by the
Governor.
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Medicaid
Reform
- SB 1484
PASSED
The creation of the medical home within the state
Medicaid program may have to wait another
year. The Senate's initial budget proposal
included a new provision that directed 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).
Late in the session, the House unveiled a Medicaid
reform proposal, which ended MediPass and fee for
service in Medicaid, and replaced those programs
with the Managed Medical Assistance Program.
Under the House's proposal, a vast majority
of Medicaid patients would be placed in a managed
care plan. Only a small, select group of Medicaid
patients would be exempt from mandatory managed
care enrollment. All care in the Managed
Medical Assistance Program would be provided by a
"qualified plan." Qualified plans would be limited
to health insurance companies, exclusive provider
organizations, health maintenance organizations
and provider service networks. Qualified
plans would be paid on a capitated, per-member
per-month basis. The proposal allowed
qualified plans to be designated as medical homes.
The plans that choose to become an accredited
medical home would receive priority in the plan
selection process for a particular region.
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 120, the claim must be paid in full.
The House amended its initial proposal to ease the
concerns of 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.
The Senate medical home plan and the House
Medicaid reform proposal were discussed during the
budget conference process. At the conclusion
of the budget conference, the Senate and House
chose not to move forward with either of the
comprehensive plans this year. In lieu of
the initial Senate and House proposals, the
Legislature directed AHCA to extend the current
Medicaid Reform waiver and preserve the Low Income
Pool provisions in the waiver. AHCA is
required to update the Legislature and Governor on
the monthly progress of the waiver extension. AHCA
is also directed to develop methodologies to
integrate the use of intergovernmental transfers
and certified public expenditures into the payment
methodology for capitated Medicaid managed care
plans.
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MediPass
Correction
Contrary to the previous report, the MediPass $2
per member per month case management fee was not
eliminated.
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Autism Spectrum
Disorder
SB 214/HB 107
FAILED
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
bills did not
pass.
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Child Restraint
Requirements in Motor Vehicles
SB
316/HB 387 FAILED
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 revised restraint requirement on a
child's height rather than age, and requires that
children age four through seven years who are less
than four feet, nine inches tall be transported in
an age appropriate restraint device. HB 387
requires 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. Under
the bills, law enforcement officers can assess a
moving violation punishable by a fine of $60 plus
court costs, and issue three points against the
driver's license. The bills did not
pass.
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Balanced
Billing
SB 2504
FAILED
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
did not
pass.
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Arbitration
Agreements Governing Certain Medical Negligence
Claims
SB 2034/HB
1529 FAILED
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. The bills did not
pass.
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Continuity of
Care
SB 516/HB 275
FAILED
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. The bills never received a
committee hearing and did not
pass.
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Sovereign Immunity for Health
Providers
SB 1474/HB
791 FAILED
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 did not
pass.
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Department of Health (DOH)
Reorganization
HB 7183
FAILED
HB 7183 by the House Health Care
Regulation Committee aims to refocus the mission
of 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.
During the budget conference process, the House
attempted to include a provision
in HB 7183 that would move
Medical Quality Assurance (MQA) services from DOH
to DBPR. This move was adamantly opposed by
organized medicine and the Senate did not agree to
the House position. MQA services will remain
under DOH's purview. Following the budget
conference, the Senate and House chose not to move
forward with HB 7183 and the bill did not
pass.
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Optometry/Oral and Topical Pharmaceutical
Agents
SB 330/HB 135
FAILED
SB 330 by Senator Mike Bennett
(R-Bradenton) and HB 135 by Representative Ron
Reagan (R-Sarasota) authorize optometrists to
prescribe thirteen different oral medications,
some of which are controlled substances. The
optometry community was very involved at the
grassroots level with legislators and solicited
support from a few ophthalmologists who expressed
support for the bills.
SB 330 received approval by the Senate Health
Regulation Committee, a committee where the bill
failed to pass in 2009. FAFP worked
diligently during the session with its partners at
the Florida Medical Association (FMA) and other
specialty societies to oppose these bad
bills. Ultimately, the bills did not
pass.
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Advanced Registered Nurse
Practitioners
SB 188/HB
677 FAILED
SB 188 by Senator Mike Bennett
(R-Bradenton) and HB 677 by Representative Juan
Zapata (R-Miami) include advanced registered nurse
practitioners to the list of practitioners
authorized to prescribe controlled
substances. The bills never received a
committee hearing and did not
pass.
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Physical Therapy
SB 2146
FAILED
SB 2146 by Senator Al Lawson
(D-Tallahassee) 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 never
received a committee hearing and did not
pass.
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Childhood
Vaccines
SB 222/HB 117
FAILED
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.
Representative Ambler withdrew HB 117 from further
consideration after public testimony from
organized medicine and other opponents spoke in
opposition to the bill.
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Health Care
Budget
HB 5001 PASSED
The state's health and human services budget is
9.35 percent more than last year's budget due to
increased Medicaid caseloads. The
Legislature did not anticipate an extension of
federal assistance for Medicaid and crafted its
budget
accordingly.
Specifically, Medicaid spending was increased by
$2.56
billion over the current year ($20.5 billion
or 29 percent of the total state budget), which is
a 14.05 percent increase due to the addition of
approximately 301,482 new Medicaid
recipients. With a total projected budget
shortfall of $3.2 billion, the Legislature focused
on funding the following priorities:
- Restored the Medically Needy and MEDS AD
Programs to approximately 39,684 beneficiaries
monthly.
- Funded the anticipated Kidcare enrollment
growth of an additional 22,374 children.
- Restored funding for services for pregnant
women who qualify at between 150-185 percent of
the federal poverty level.
Programs within AHCA received numerous reductions.
Following are some of the key funding
decisions:
-
Reduced nursing home reimbursement rates by
7 percent, effective July 1, 2010 ($199.4
million). However, the Legislature
provided an option for nursing homes to
partially restore this reduction through its
quality assessment program. This option is
contingent upon the extension of the federal
stimulus funds through July 2011.
-
Reduced hospice reimbursement rates by 7
percent, effective July 1, 2009 ($17.5 million).
Legislators also offered these providers a
partial buy back of rate reductions through the
quality assessment program.
-
Reduced county health department
reimbursement rates to the level paid to
Federally Qualified Health Centers (FQHC) ($40.4
million). The county health departments
are permitted to buy back rate reductions
through county intergovernmental transfers.
-
Reduced hospital inpatient and outpatient
rates by 7 percent ($287 million) effective July
1, 2010. The plan exempts children's specialty
and rural hospitals. Some hospitals have
the ability to buy back rate reductions through
the use of intergovernmental transfers, if
available.
-
Reduced prepaid health plan payments by
$63.3 million based on the projected Medicaid
Prepaid Health Plan rates effective September 1,
2009. Prepaid health plan reimbursement
rates are calculated as a percentage of the
hospital inpatient, hospital outpatient and
County Health Department Clinic rates, and
receive a corresponding reduction when hospital
inpatient rates are reduced.
DOH also faced severe budget reductions this
year. DOH's budget is $2.9 billion, a
decrease of $32.7 million in general revenue over
the current year's spending, which represents a
roughly a 1.1 percent decrease. DOH's
administration was reduced by $6.3 million in
general revenue funds. Some notable spending
areas include the following:
- DOH's budget for next year provides $26.1
million in targeted stimulus
funds:
o $9.7 million for Early Learning
Intervention Services;
o $4.4 million for Immunizations
Services, $1.4 million for Community Health
Centers;
o $2.9 million for Behavioral
Risk Factor Surveillance and Diabetes
Prevention programs; and
o $9 million for Communities
Putting Prevention to
Work.
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DOH's budget allocates $1.5 million for the
Rural Diversity Minority Healthcare Program and
$19.9 million for maintenance, repair and
capital improvement projects to county health
departments.
-
Other DOH reductions include:
o Special projects
($624,000);
o Area Health Education Center
Networks ($4.9 million);
o Children's Medical Services
($3.4 million);
o Healthy Start Coalitions ($2.6
million);
o Florida Center for Nursing
($450,000); and
o Contributions to county health
departments ($30.1 million) in general revenue
funds.
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We hope you found FAFP's 2010 Capitol Updates
informative. Please let us know if you have
any questions about any of the issues included in
the update.
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