Step therapy amendment added to latest health care train bill

Don Gaetz

A Senate committee tagged a controversial health care bill to a measure expanding the scope of practice for Florida’s nurses, a priority for the Florida House this year.

The Senate Rules Committee on Monday committee agreed to tack on an amendment to CS/CS/SB 614 that would allow doctors to override step therapy protocols within 24 hours if a physician believes, based on sound medical evidence, that the step therapy treatment would be ineffective or would cause an adverse reaction.

Former Senate President Don Gaetz offered the last-minute amendment, which caught Sen. Denise Grimsley off guard.

Grimsley, who worked closely last year with Gaetz on the FMA language, then deferred for about 90 minutes as members worked it out.

Meanwhile, Sen. Lizbeth Benacquisto offered another amendment — which would have amended  medical tourism and direct primary carebut it was withdrawn after Sen. Jack Latvala started raising concerns about a potential fiscal impact of the medical tourism provision. The amendment was the subject of the free-standing measure sponsored by Sen. Aaron Bean, SB 7084.

The flurry of amendments shows the sentiment that when it comes to health care and insurance regulation this year, the approach is to make a train.

CS/SB 614 has language the FMA supports that requires insurers and HMOs and pharmacy benefit managers that don’t to use an online prior authorization form with their providers to use standardized prior authorization form beginning January 2016, developed by the Florida Services Commission.

It also has language that would prohibit insurance companies and HMOs from retroactively denying claims if they at any time in the course of treatment verified patient insurance and provided authorization numbers.

The FMA issues were a priority for Gaetz last year, but they became a poison pill because it was a non starter in the Florida House.

The underlying bill authorizes physician assistants and advanced registered nurse practitioners to prescribe controlled substances under supervisory standards. The committee tagged on a strike-all amendment that put restrictions into the bill.

Tallahassee lobbyist Alisa LaPolt said the nurses don’t really like the restrictions but “if it’s going to get the bill through the committee, then we’re behind it. None of the provisions are deal breakers.”

LaPolt, who represents Florida nurses, said CS/CS/SB 614 is now a bill that organized medicine and the nurses both like. When asked whether the Gaetz language could jeopardize the measure LaPolt said she didn’t want to call it a “poison pill. Not quite yet.”

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.



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