Omnibus Health Care Bill (aka House Health Care Train)
Omnibus Health Care Bill (aka House Health Care Train)
The House Health & Human Services Committee passed House Bill 7113 by Representative Jason Brodeur (R-Sanford) after adopting a strike all amendment that includes provisions on health care topics previously addressed in separate bills. Provisions now include: trauma centers, telehealth, certificate of need, advanced registered nurse practitioner (ARNP) scope of practice, obstetrical service notice, medical tourism, and the Prescription Drug Monitoring Program Database.
House Bill 7113 was amended to grandfather in three trauma centers that have been in operation for 12 consecutive months preceding the effective date of the bill. Another amendment was adopted that would place a one-year cap on trauma activation fees at $15,000 and require hospitals to post its activation fee amount on its website home page and in a conspicuous place within the trauma center. The bill also revises the designation of trauma service areas, an issue that FHA raised concerns about. The bill will now be placed on the calendar for consideration in the House chamber. Similar legislation in the Senate – Senate Bill 1276 by Senator Denise Grimsley – passed in the Appropriations Committee. The bill directs the Florida Department of Health to convene the Florida Trauma System Plan Advisory Council (Council) to review the Trauma System Consultation Report issued by the American College of Surgeons Committee on Trauma dated February 2013 and submit recommendations, including the need for legislation, to the Legislature by Feb. 1, 2015. The Senate bill also caps trauma activation fees at $15,000. An amendment was adopted that specified the membership for the Council, revised the grandfather language and placed a one-year moratorium on any new trauma centers. The bill will now be placed on the calendar for consideration in the Senate chamber.
Previously addressed in House Bill 751 by Representative Travis Cummings (R-Orange Park), House Bill 7113 would permit all licensed health professionals to use telehealth to deliver health care services within their respective areas of specialty. It also would establish eligibility requirements for out-of-state providers and would require them to register with the Florida Department of Health that would list all out-of-state providers on their website. House Bill 7113 will now be placed on the calendar for consideration in the House chamber. In the Senate, Senate Bill 1646 by Senator Aaron Bean (R-Jacksonville) and the Health Policy Committee passed in the Appropriations Subcommittee on Health and Human Services. An amendment by Senator Bean that proposed to expand the definition of telemedicine provider to include physicians and other health professionals, and allow out-of-state practitioners, failed to pass. Two amendments offered by Senator Rene Garcia (R-Hialeah) were adopted that define telemedicine providers to include physicians, physician assistants, ARNPs or pharmacists, require liability coverage for telemedicine providers and a requirement for board approved training and examination on telemedicine standards. The bill will now be referred to the Appropriations Committee for consideration.
Certificate of Need (CON)
Not previously included in another bill, House Bill 7113 was amended to include a CON exemption for hospitals with at least 500 beds that meet defined criteria related to indigent care and bond credit rating. Qualified hospitals would be permitted to relocate up to 15 percent of their licensed acute care beds within the county where the hospital is located. FHA raised concerns about this CON deregulation. There is no legislation in the Senate that includes a similar provision.
Advanced Registered Nurse Practitioner (ARNP) Scope of Practice
Previously House Bill 7071 by Representative Cary Pigman (R-Sebring) and the Select Committee on Health Care Workforce Innovation, House Bill 7113 now includes provisions that would authorize ARNPs to prescribe controlled substances within the framework of a supervisory protocol with a physician. It would also authorize independent practice for ARNPs with a specified level of experience and education, excluding those specialized as certified registered nurse anesthetists and certified nurse midwives. In addition, it would allow all ARNPs to initiate the Baker Act and those who are certified as psychiatric mental health independent practitioners would be allowed to release Baker Act patients. Amendments to delete or significantly revise the ARNP scope of practice segment of the bill were offered but were not adopted. The bill will now go to the House chamber for consideration. Similar legislation in the Senate - Senate Bill 1352 by Senator Denise Grimsley (R-Sebring) - is currently in the Judiciary Committee.
OB Service Notice; Surgical Assistants and Technologists Certification
Previously addressed in House Bill 373 by Representative Kathleen Peters (R-Fernandina Beach), House Bill 7113 was amended to include a provision that requires a hospital to notify their obstetrical (OB) physicians at least 120 days before closing its OB services. The bill will now be placed on the calendar for consideration in the House chamber. In the Senate, Senate Bill 380 by Senator Aaron Bean (R-Jacksonville) passed in the Senate and will now be sent to the House for consideration. The first part of the Senate bill includes the OB services notice provision that is now in the House Bill. The second part of the Senate bill would require hospitals to employ only certified surgical assistants and technologists. FHA has taken a position that both of these provisions are not necessary legislation. The Senate bill passed in the Senate chamber and has been sent to the House for consideration.
Previously addressed in House Bill 1223 by Representative Patrick Rooney (R-Palm Beach Gardens), House Bill 7113 was amended to include provisions directing Enterprise Florida and Visit Florida to promote medical tourism and market the state as a healthcare destination. It also allocates $5 million to the Florida Tourism Industry Marketing Corporation for this purpose. The bill will now be placed on the calendar for consideration in the House chamber. Similar legislation in the Senate – Senate Bill 1150 by Senator Aaron Bean (R-Jacksonville) – passed by unanimous vote in the Appropriations Committee and will now be placed on the calendar for consideration in the Senate chamber.
Prescription Drug Monitoring Program (PDMP) Database
House Bill 7113 was amended to include new language on a provision that would require all health care professionals, including physicians and ARNPs, to access the PDMP database upon the initial visit with a patient before issuing a prescription for a controlled substance. It also allocates $500,000 in nonrecurring funds for the administration of the PDMP. The bill will now be placed on the calendar for consideration in the House chamber.
Previously addressed in House Bill 7111 by the Health Innovation Committee, House Bill 573 by Representative Larry Ahern (R-Seminole) was amended to include overnight stays for ambulatory surgical centers and established a new licensure category for recovery care centers. The bill passed on a 14-3 vote out of the Health & Human Services Committee. The first part of the bill pertains to Assisted Living Facilities (ALFs) and would make regulatory changes to address quality of care. The provisions related to ambulatory surgical centers changes the length of stay from the requirement to discharge the patient by midnight on the day of the operation to permit an overnight stay up to 24 hours following admission. The bill would also create a new entity known as a recovery care center that would provide post-surgical, post-medical and general nursing care to patients and, as amended, keep patients for up to 72 hours. FHA testified in opposition to the bill and raised concerns about quality, as well as the negative impact on existing hospitals and nursing homes. The bill will now be placed on the calendar for consideration in the House chamber.
Workers' Compensation Fees
Senate Bill 1580 by Senator Alan Hays (R-Umatilla) passed in the Health Policy Committee by a unanimous vote. The bill would have limited workers’ compensation reimbursement rates for hospitals inpatient and outpatient stays to 140 percent of the Medicare rate. However, an amendment, previously offered by Senator Hays, removed this provision and replaced it with the creation of a task force to study workers’ compensation system cost drivers. Several amendments were adopted related to the membership of the task force as well as a directive to the Office of Insurance Regulation to prepare a report analyzing savings to Florida employers related to negotiated premiums. The bill will now be referred to the Appropriations Committee for consideration. In the House, House Bill 1351 Representative Charlie Stone (R-Ocala) was not heard this week. The House bill would limit workers’ compensation reimbursement similarly to the original Senate language. It has now been referred to Government Operations Appropriations subcommittee for consideration.
Crisis Stabilization Units (CSUs)
Senate Bill 1726 by Children, Families and Elder Affairs passed by a unanimous vote in the Appropriations Committee. The original bill language would have replaced the current "bed available" payment system with a per diem reimbursement methodology for CSU services. However, a strike-all amendment by Senator Denise Grimsley (R-Sebring) was adopted that removed the reimbursement change and requires CSUs to report selected data to the Managed Entities in a format that can be shared with the Department of Children and Families (DCF). The purpose of the data collection is to facilitate the evaluation of Baker Act fund utilization. DCF is directed to report to the Legislature by January 2015, and annually thereafter, with a detailed analysis of the data. The strike-all amendment was supported by the FHA Psych Council. The bill will now be placed on the calendar for consideration in the Senate chamber.
Baker Act Initiation
Senate Bill 1544 by Senator Oscar Braynon (D-Miami Gardens) was on the agenda in the Children, Families and Elder Affairs Committee this week. However, Committee Chair Senator Eleanor Sobel (D-Hollywood) announced that the bill would not be heard and was temporarily postponed. The original bill language would have added advanced registered nurse practitioner (ARNPs) and physician assistants (PAs) to the list of health care professionals who can initiate involuntary examinations under Baker Act, however, it did not include the important provision that would authorize psychiatric certified ARNPs to release patients from Baker Act. In addition, Senator Braynon filed an amendment that stripped nurses out of the language altogether. FHA urged the sponsor to file a substitute amendment that would have authorized psychiatric certified ARNPs to both initiate and release patients under Baker Act. At this point, the bill is essentially dead for this session, though similar legislation in the House – House Bill 829 by Representative Daphne Campbell (D-Miami Gardens) – is positioned to pass in the House chamber.
Florida Mental Health Act – Baker Act
Senate Bill 1584 by Senator Joseph Abruzzo (D-Wellington) passed in the Children, Families and Elder Affairs Committee. The bill directs the Department of Children and Families to create a work group to evaluate methods to improve the operational effectiveness of the Florida Mental Health Act, known as the Baker Act. The bill will now be referred to the Judiciary Committee for consideration. A similar bill in the House – House Bill 1245 by Representative Lori Berman (D-Boynton Beach) – has been referred to several committees for consideration but has not yet been taken up.
Agency for Healthcare Administration (AHCA) Data
Senate Bill 782 by Senator Jeff Brandes (R-St. Petersburg) passed by unanimous vote in the Appropriations Committee. The bill proposes numerous data and information requirements related to the collection of personal identification information, assisted living facility data and comprehensive health information data. The bill would eliminate AHCA's Florida Center for Health Information and Policy Analysis, which currently collects, compiles, coordinates, analyzes and disseminates health related data and statistics. In addition, the bill creates the Florida Health Information Transparency Initiative that would make state-collected data on health providers, facilities, services and payment sources available in a manner that allows for and encourages multiple innovative uses for the data. An amendment was adopted appropriating funds to facilitate implementation by AHCA. The bill will now be placed on the calendar for consideration in the Senate chamber. A similar bill in the House – House Bill 1231 by Representative Halsey Beshears (R-Apalachicola) – was not heard this week and has been referred to the Appropriations Committee for consideration.
Previously addressed in Senate Bill 1470 by Senator Geraldine Thompson (D-Orlando), Senate Bill 1066 by Senator Denise Grimsley (R-Sebring) was amended to revise HIV testing requirements. The bill no longer requires hospitals and other health care setting providers to obtain informed consent from the HIV test subject and specifies requirements for notification of the individual to be tested. The bill will now be referred to the Appropriations Committee for consideration. The House companion – House Bill 1225 by Representative Joe Saunders (D-Orlando) and Representative Cary Pigman (R-Sebring) – has been placed on the calendar for consideration in the House chamber.
Infectious Disease Control
House Bill 647 by Representative Janet Adkins (R-Fernandina Beach) passed by unanimous vote in the Health Care Appropriations Subcommittee. An amendment was adopted to align the bill with Senate language. It has now been referred to the Health & Human Services Committee for consideration; however, this committee is not expected to meet again during this session. Senate Bill 992 by Senator Aaron Bean (R-Jacksonville) was previously amended directing the Florida Department of Health to convene a study group to assess the state’s current system for addressing antibiotic-resistant bacteria data collection and prevention. The group would report its findings and action plan, along with their determination of need for necessary legislation, to the Governor and the Legislature by July 1, 2015. The bill has been referred to the Health Care Appropriations Subcommittee for consideration.
Needle Exchange Pilot Program
House Bill 491 by Representative Mark Pafford (D-West Palm Beach) passed by a unanimous vote in the Health & Human Services Committee. The bill creates the “Miami-Dade Infectious Disease Elimination Act” and requires the Florida Department of Health to establish a sterile needle and syringe exchange pilot program in Miami-Dade County. Such programs are endorsed by the National Institute on Drug Abuse and have been proven through implementation in other urban cities to significantly reduce the transmission of blood-borne pathogens including HIV and Viral Hepatitis B and C. The bill will now be placed on the calendar for consideration in the House chamber. The Senate companion – Senate Bill 408 by Senator Oscar Braynon (D-Miami Gardens) – has been placed on the calendar for consideration in the Senate chamber.
Senate Bill 722 by Senator Rene Garcia (R-Miami) passed by unanimous vote in Judiciary Committee. The bill expands the list of health care providers who may receive the results of a newborn’s hearing or metabolic tests or screenings from the State Public Health Laboratory and revises the definition of “hearing impairment” to conform to national standards. The bill directs health care practitioners who diagnose a child with hearing loss to offer the parent or guardian an opportunity to receive information about services directly from specified providers that offer speech and language services. The bill has been amended to align with the House language that was previously revised to address “notification of providers” and delete the revised definition of hearing impairment. The House companion – House Bill 591 by Representative Gayle Harrell (R-Port St. Lucie) – passed in the House chamber and has been sent to the Senate for consideration.
House Bill 1059 by Representative Cary Pigman (R-Sebring) passed by unanimous vote in the Education Committee following the adoption of an amendment to align the language with the Senate bill. The bill addresses a negative student outcome trend for declining statewide nursing license examination pass rates. The bill would require all professional nursing programs – those with bachelor’s degree or associate degree level nursing graduates who are eligible to take the registered nurse license examination – to be accredited within five years by a specialized nursing accrediting agency. The bill would also exempt nurses who are certified in their area of specialty practice from Board of Nursing continuing education requirements. The bill was previously amended by Committee Chair Eric Fresen (R-Miami) requiring nursing program graduates to take the nursing licensure examination within six months following graduation and would allow the Board of Nursing to extend probationary status by one year. The bill will now be placed on the calendar for consideration in the House chamber. The Senate companion – Senate Bill 1036 by Senator Denise Grimsley (R-Sebring) – passed in the Senate chamber and will now be sent to the House for consideration
Several bills have been filed this year related to red-light camera violations. FHA is monitoring this legislation because a portion of the red-light violation fines are distributed to hospital trauma centers. This week, House Bill 7005 by Representative Frank Artiles (R-Miami) passed by unanimous vote in the Economic Affairs Committee. An amendment was adopted that revises the red light infraction when the driver is making right and left hand turns. It would also require that 70 percent of funds collected from violations be retained by the county or municipality and used for traffic safety projects. Similar legislation in the Senate – Senate Bill 144 by Senator Jeff Brandes (R-St. Petersburg) was not taken up this week in the Transportation Committee.
Managed Care Contracting
Senate Bill 1354 by Senator Denise Grimsley (R-Sebring) passed in the Banking and Insurance Committee. The bill revises the managed care accountability contract provisions for the statewide Managed Medical Assistance contracts under the Statewide Medicaid Managed Care Program. A similar bill in the House – House Bill 1001 by Representative Jason Brodeur (R-Sanford) – has been referred to the Health Care Appropriations Subcommittee for consideration.
State Group Insurance Program – Price Transparency Pilot Project
House Bill 7157 by Representative Jason Brodeur (R-Sanford) passed on a 17-10 vote in the Appropriations Committee this week and relates to the State Group Insurance Program. One section in the bill directs the Department of Management Services to implement a three-year Price Transparency Pilot Project in at least one, but not more than three, areas of the state. The purpose of the project is to reward value-based pricing by publishing the prices of certain diagnostic and surgical procedures and sharing any savings generated by the enrollee’s choice of providers. Participation in the project would be voluntary for state employees. If an enrollee selects a provider who offers the procedure at a price below the benchmark, the state would pay to the employee fifty percent of the difference between the benchmark and the price paid. The bill will now be placed on the calendar for consideration in the House chamber. There is currently no similar legislation in the Senate.