By: Dave Davidson
It’s that time of year. People are scrambling around, deciding what they want to give and what they want to get. Brand new packages are being wrapped up and filed away. Excitement and tension fill the air. Everyone can’t wait for the big day; but in this season that big day doesn’t happen until the first Tuesday after the first Monday in March. But it’s never too early to start getting ready, right? In fact, the Florida Legislature is currently in session, drafting and filing bills that the sponsors hope will be considered in March and will become law in 2016. And as usual, health care is on a lot of legislative wish lists. Although all of these bills are subject to significant revision, and some may never make it out of a subcommittee, here’s a sneak peek of some of the proposed health care legislation (without editorial – for now).
Scope of Practice Expansion
Three categories of health care professionals may see significant expansion of the scope of their practice.
Both Advanced Registered Nurse Practitioners and Physician Assistants would gain the right to prescribe controlled substances pursuant to Senate Bill 676. Most of the details about specific medications and dosages is left to an administrative committee, but the bill seems to anticipate broad authority. The bill also adds references to ARNPs and PAs throughout the Florida Statutes, indicating a willingness to accept these professionals into a significant role in the delivery of care. Additionally, SB 572 would add PAs and ARNPs to the list of providers who can certify that an individual meets Baker Act criteria to justify a patient’s involuntarily confinement for mental health reasons.
Pharmacists would also see an expansion of the duties permitted by their license under SB 692. This bill would allow Consulting Pharmacists and Doctors of Pharmacy to provide medical management services, patient health and wellness assessments, counseling, and referral services related to medications and other health care services. The pharmacists would be able to order labs, diagnostic and clinical testing and initiate, modify, discuss, and administer medications in collaboration with other health care providers. Most significantly, the pharmacists would be able to charge for these services separately from their dispensing activities.
One of the most significant changes to reimbursement is in SB 676. This bill would prohibit denial of any claim in which a health plan verified the patient’s eligibility for care and provided an authorization number for treatment. Currently, payors have a one year window in which to deny these claims, despite verification and authorization. This would absolutely prohibit those denials.
Another limitation on health plans that should work in favor of patients and providers is the limitation on “First Fail” or “Step” protocols proposed in SB 210. Health plans commonly establish these protocols to require providers to try certain treatments before moving on to more aggressive (and potentially expensive) treatment. This bill would require health plans to approve a provider’s request to override a protocol within 24 hours, if the provider demonstrates that the initial treatment would be ineffective or would harm the patient. Additionally, if a provider follows the protocol, it is up to the provider, not the health plan, to determine how long the initial treatment should be tried before concluding it to be ineffective. In those cases the provider can implement another treatment without approval of the health plan.
Florida law currently prohibits providers from referring patients to facilities in which they have an ownership interest for designated health services, unless the interest is in a publicly traded company with assets over $50 million. Senate Bill 108 would increase the asset threshold to $75 million, but even then would still prohibit a referral if that company loaned or guaranteed money to the referring provider so the provider could purchase the ownership interest. The law is clear that the bill is not intended to create a new safe harbor or contravene the fraud and abuse laws.
Senate Bill 128 would officially recognize Direct Primary Care Agreements, which are agreements under which primary care physicians agree to provide care to patients for a fixed monthly fee. If the law is passed, these agreements would need to meet specified criteria, but even though there is an element of risk involved, the agreements would be exempt from insurance regulations.
Senate Bill 664 proposes a new type of physician order that can serve as an advance directive. A Physician Order for Life Sustaining Treatment (POLST) is an order entered by a physician, on a form to be developed by the state, which sets out a patient’s wishes, and provides an order for the desired care in the event the patient has an end stage or life-limiting condition. POLSTs would generally provide for compassionate and palliative care for patients who do not yet qualify for hospice care.
Recovery Care Centers are facilities that provide post-surgical recovery care for patients who do not need acute hospital care following a procedure, but who may not be ready to go home. Under SB 212, the state would regulate these facilities under the same chapter as hospitals and ambulatory surgery centers.
Senate Bill 676 removes the practice parameters for performance of cesarean sections, and also requires hospitals to give 90 days notice before discontinuing obstetrical services. House Bill 471 would require 120 days advance notice before discontinuing obstetrical services.
House Bill 187 establishes specific nurse-to-patient ratios for various hospital departments. The bill would do away with mandatory overtime, eliminate the use of monitors in place of care givers, and prohibit the use of unlicensed personnel. It would also give nurses the right to personally sue a hospital in the event of a violation of the requirements.
Two bills address hospital Certificate of Need requirements. Senate Bill 236 proposes to removes the geographic restrictions for replacement rural hospitals without a CON, while HB 437 would remove hospitals from the CON requirements altogether.
Hospitals would be required to establish patient lifting and handling protocols to help prevent workplace injuries pursuant to HB 486.
Three bills have been filed dealing with marijuana. Senate Bill 616 and HB 4021 would remove marijuana from the list of controlled substances, while HB63 would allow the cultivation, sale, possession and use of low-THC marijuana.
Two bills legislatively recognize two new clinical practices. Music Therapy is established by SB 204 and Art Therapy is established by SB 594. The bills also establish practice parameters and regulations for the therapists providing the services.
Senate Bill 178 charges Enterprise Florida with marketing Florida as a health care destination, seeking to attract medical “tourists.” It also allows the state to market Florida providers as “showcase” providers.
The Infectious Disease Elimination Act (IDEA) is a pilot program proposed for Miami-Dade County by SB 242. This bill would establish a program which would provide sterile needles and syringes in exchange for soiled ones on a one-for-one basis.
The work parameters of Certified Community Health Care Workers in promoting health care in medically underserved communities is established in SB 244.
And finally SB 378 establishes the Pediatric Cardiac Advisory Council and Pediatric and Congenital Cardiovascular Centers of Excellence.
As I said, it remains to be seen how many of these bills become law, but it never hurts to keep an eye on what’s going on in Tallahassee. ‘Tis the season.