Christine Jordan Sexton
Health care financing isn’t the only unresolved issue heading into the final week of the 2015 Legislative Session.
A significant amount of health care policy — from deciding the role advanced registered nurse practitioners should have in an ever-evolving delivery system to whether doctors should be allowed to override insurance companies and HMOs as they struggle to hold down health care costs — remains outstanding.
Jacksonville lawyer Christopher Nuland has been lobbying health care issues in the Florida Legislature and at state government agencies for the last 20 years. Nuland said the expectation is that the Legislature will create a “train” for health care legislation and, for now, the bill that appear to be the vehicle for the train is SB 532, HB 281. The issues that are expected to be included in the train include:
- Developing a site selection process for a new Veteran’s Administration nursing home;
- Allowing physicians to participate in direct primary care;
- Allowing advanced registered nurse practitioners and physician assistants to prescribe and order controlled substances in a hospitals, and;
- Clarifying in statute that free clinics can receive an appropriation, or grant from an appropriation, to provide services to the uninsured while preserving their sovereign immunity protection
Nuland said that “trains” — when several bills are rolled into one package — have become common in the past several years in Tallahassee. He attributes that to federal health care reform. “The stakes have gotten higher with Obamacare,” he said. “It’s almost impossible to pass a good, single-policy health care bill.”
Nevertheless, Nuland said that he’s expects the Legislature will pass the issues this year: “I’m optimistic. You can’t lobby for 20 years and not believe the system will work.”
Health care financing and whether to expand Medicaid to working uninsured has become the overarching issue in the 2015 legislative session. The chambers’ disagreement over $4 billion-plus in Medicaid financing has proved impossible to bridge thus far. As the chambers continue to try to resolve the budget, House Speaker Steve Crisafulli and Senate Appropriations Chairman Sen. Tom Lee have both said allowing ambulatory surgical centers to take patients for 24 hours, licensing recovery care centers to treat stabilized patients for up to 72 hours (HB 999), and certificate of need reforms also may become part of the health care debate. Those controversial issues — which take aim at Florida’s hospital industry — are only being talked about as part of the budget debate and not part of a health care train.
Meanwhile, some lower profile health care related bills — about a dozen — have made their way through the Legislature. They include:
- HB 697, which allows the surgeon general to isolate an individual who has who has a communicable disease that has a significant risk of morbidity or mortality. It authorizes law enforcement officers to immediately enforce orders by the Department of Health that relate to the isolation or quarantine of persons, animals, and premises when controlling communicable diseases or providing protection from unsafe conditions that pose a threat to public health.
- HB 889, which amends Florida’s health care surrogates law to allow a person to designate a health care surrogate, who may act at any time, including while an adult is still competent and able to make his or her own decisions.
- CS/HB 309, which requires that if a hospital places a patient on “observation status” rather than inpatient status, the observation services shall be documented in the patient’s discharge papers and notice be given to the patient or patient’s proxy of the status.
Scores of other high-profile health care bills — food fights between those in the health care industry — appeared all but dead headed into the last week of session. Examples of those are:
- SB 1400/HB 1119, which would restrict prescription contact lens manufacturers from preventing a retailer from selling or advertising a contact lens to a consumer below a specified price;
- CS/SB 784/HB 863, establishing the Right Medicine, Right Time Act, would create a state commission to review prior authorization, step therapy, or other protocols, submitted by health maintenance organizations, insurers, or Medicaid managed care plans, that limit access to determine if the limitations were supported by clinical evidence;
- SB 516/HB 681, creating a payment methodology for emergency services and care provided by noncontract providers to members of a PPO or EPO and prohibits those providers from collecting or attempting to collect any additional amount.
As of Friday, 128 bills had made their way through the process with just one week left to go.
