The issue of scope of practice is front and center in Florida right now with the expansion of what nurse practitioners (and nurse midwives) are legally permitted to do. The newly enacted 464.0123 allows for qualified APRNs (there is specific criteria) to practice independent of a supervising physician in the following areas of medicine–primary care, family medicine, general pediatrics, and general internal medicine.
Even more, assuming they meet the membership criteria for admission to a healthcare facility medical staff, they may admit patients, manage patient care, and discharge patients. One of the only preserved connections with a physician established by the law is if the APRN practices at a healthcare facility, a transfer agreement including a physician is required. Additionally, the new law establishes a Council On Advanced Practice Registered Nurse Autonomous Practice, two members of which are appointed by the Board of Medicine and an additional two appointed by the Board of Osteopathic Medicine.
When the Governor issued Executive Order 20-72, essentially shutting down any healthcare service that isn’t urgent, it sent the entire Florida healthcare industry into a tail spin. In recognition of that fact, many industry trade groups circled back to Florida government and sought clarification. Attached is one report of such a clarification issued by the Florida Medical Association.
The FMA interpretation of Executive Order 20-72 is that only medically unnecessary, non-urgent or non-emergency procedures or surgeries are prohibited. This has been confirmed by staff at the Florida Department of Health in communications to the FMA this morning.
The Department of Health also confirmed that Physicians can continue to see patients for purposes of evaluation and management. Telemedicine visits can continue unabated. Primary care practitioners can continue to see and treat patients with chronic and acute conditions, perform wellness exams, and provide mental health services, that do not consume personal protective equipment. Specialists can see patients for follow-up care and other non-surgical purposes.
The medical care prohibited under this order is: • elective or non-medically necessary surgical procedures • surgical procedures that can be postponed without putting the patient’s immediate health, safety or well-being at risk • medical procedures that would consume personal protective equipment, that can be postponed without putting the patient’s immediate health, safety or well-being at risk
Physicians should consult the CMS recommendations for additional guidance. We understand the negative impact this will have on countless physicians and their patients. The FMA will be here to help guide you through this unprecedented event. If you have any questions please contact the FMA General Counsel’s office at firstname.lastname@example.org or call 850 224-6496.
CMS has rolled out a telehealth/telemedicine tool kit to assist medical professionals with health care delivery during the current COVID-19 public health emergency.
The toolkit contains information and links concerning:
1135 Waivers – allows the Secretary of HHS to temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure sufficient health care services and items are available to meet the needs of individuals enrolled in Social Security Act programs during the emergency and that providers who provide services in good faith can be reimbursed and exempted from sanctions (provided there is no determination of fraud and abuse). 1135 waiver or modifications include:
Conditions of participation and other certification requirements;
Program participation and similar requirements;
State licensing requirements where services are rendered as long as the provider has equivalent licensing in another State (for Medicare, Medicaid, CHIP reimbursement only; State licensing still controls whether a non-Federal provider may provide services in a state he/she is not licensed in);
EMTALA sanctions for redirection for medical screening, as long as redirection is not the result of discrimination on the basis of a patient’s source of payment or ability to pay;
Stark self-referral sanctions;
Adjustment (not waiver) to performance deadlines and timetables;
Limitations on payment to permit Medicare enrollees to use out of network providers in an emergency situation.
Florida’s Governor passed an Executive Order Friday which essentially shuts down all elective medical treatment. The Order (20-72) only allows “non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or wellbeing at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”
Join Florida Healthcare Law Firm Attorney Chase Howard on our free webinar titled “How can you transform your business to be prepared for future situations like COVID-19?”
Faced with the reality of remote operation, we’ll talk about how your business prepare to thrive in a similar scenario in the future.
What to do with remote staff when it comes to contracts, operations and patient privacy.
How do Federal regulations impact telework.
Could expanded telehealth laws ease the transition to remote care in a future crisis.
Presenter:Chase Howard, Esq. is an Attorney at the Florida Healthcare Law Firm and has focused his legal practice on health law, medical malpractice defense, business law, and contracts. He deploys crucial skills gained through hands-on business experience in the medical tech world to service clientele such as medical spas, medical practices, medical technology businesses, healthcare business entities, physicians, chiropractors, and dentists. Chase’s experience working in University of Miami Health System’s Risk Management Department provided him with a strong understanding of legal compliance in the healthcare world as well as experience in liability assessment, prevention and defense. With his multi-specialty background, Chase’s practice focuses on all aspects of transactional Health Law, MedSpa Start-up and consulting, general business law, and MedTech.
On March 16, 2020, Florida became the first state to receive a Medicaid waiver from CMS in response to the COVID-19 national emergency. These provider enrollment emergency relief efforts also apply to the Children’s Health Insurance Program (CHIP), as applicable. With this waiver, Florida Medicaid, and Medicaid providers, will have greater flexibility in treating covered patients. Pursuant to the Florida waiver:
Up until now, Medicare has been fairly structured in how telehealth services are reimbursed. Medicare would pay for telehealth services only if certain, very narrow criteria were met. These rules covered the patient, the patient’s location, the provider, the types of services rendered, the telehealth equipment used and the way the services are coded. Those rules can now be relaxed under recent federal legislation.
On March 6, 2020, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 into law. That law relaxes the current Medicare criteria, in order to expand the use of telehealth as a resource against COVID-19. Pursuant to this law, the Secretary of HHS has the authority to waive the “site” requirements for telehealth services provided to Medicare beneficiaries who are located in an identified “Emergency Area” during an “Emergency Period.” Since the whole country is currently is experiencing a public health emergency, as declared by both the President and the Secretary of HHS, the Emergency Period and Emergency Area requirements are met on a nation-wide basis.
The Florida Healthcare Law Firm is hosting a free webinar for physicians on appropriate third party relationships. With shrinking reimbursement rates, physicians are increasingly turning to alternative methods and innovative physician relationships to increase revenue. However, not every opportunity is compliant with Federal and State kickback laws, which are designed to prevent overutilization of services.
This course aims to help attendees recognize and advise physicians about relationships designed to compensate for more than just patient care, including, but not limited to:
It will use recent trends in the market to reinforce its objectives. This free webinar is for physicians and healthcare providers full of valuable information.All you have to do is register here, put it on your calendar and then click on the link emailed to you on March 25th!
Physician relationships of any kind should be approached carefully by a highly qualified healthcare attorney. Nearly every aspect of healthcare is governed by a complex array of regulations and remaining compliant when drafting a contractual relationship of any kind is no easy task.
After more than a year of debate, edits, tabling and lobbying, the Florida Legislature passed multiple bills that would allow advanced practice registered nurses (APRN) to practice independently of physicians, as well as authorize certain pharmacists to test and treat patients for the flu and strep throat, among other conditions.
Prior to passage of these bills, APRNs were required to have some level of physician supervision in order to practice. While in many cases direct supervision is not required, Florida law required that an APRN enter into a supervisory relationship with a Florida licensed physician. Specifically, the providers must draft written protocols regarding scope of practice, as well as provide certain notices to their governing boards and patients. While the requirements vary based on the type of practice, they aren’t difficult to comply with in most cases. Finding a supervising physician outside of that physician’s primary practice, however, might prove to be more difficult than it seems. The requirements also carry certain mileage restrictions, prohibiting supervision outside mile limits based on the level and type of supervision.
On March 4, 2020, the Centers for Medicare & Medicaid Services (CMS) issued three Quality, Safety & Oversight Memoranda, all concerning the Coronavirus. According to these documents, effective immediately, the government will begin to focus its inspections exclusively on issues related to infection control and other serious health and safety threats. According to CMS Administrator Seema Verma, the memoranda should be seen as a “call to action across the healthcare system.” The goal of the guidance given in the memoranda is to continue to keep Americans safe and prevent the spread of the Coronavirus.
The first memorandum resets the focus of governmental surveys. The order of priority for government surveys will now be:
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.