Florida Gastroenterological Society
Florida Gastroenterological Society

2015 Legislative Session Updates

Keeping FGS members up to date on key issues being debated at the state capital is a primary focus for the association. Below are the weekly legislative session updates provided to FGS members.

Week 6 Legislative Report
by Christopher L. Nuland, Esq.

The Legislature just completed its sixth and final week of pre-Session Committee hearings, tackling several thorny issues and setting the stage for what likely will be an eventful Legislative Session.

On Tuesday, the Senate Health Policy Committee passed a Medical Tourism bill (SB 178) that will internationally promote the expertise of Florida health care and should be a boon to all Florida
physicians.  During the same hearing, the Committee also passed legislation that would require insurance coverage for opioid antagonists to the same extent as the opioids themselves.

Later that afternoon came the major fireworks, as the House Health Quality Committee considered a bill that, as written, would allow pharmacists the right to practice medicine.  After an hour of contentious debate, the bill was tabled, and any resulting bill will almost certainly not include an independent practice provision.

Wednesday saw the postponement of the controversial ER Price Fixing bill that would force even non-contracted physicians to accept the insurance payment as payment in full for ER services.  Unfortunately, we do expect this bill to re-emerge during the first week of Session.

By Thursday the venue had shifted from Tallahassee to Jacksonville, where the Board of Medicine is meeting to discuss, among other things, its legislative agenda and office surgery.  As always, we are there working for our members, and we will let you know of any exciting developments.

 


Committee Week 5 Update

It may have taken awhile, but the Florida Legislature this week began its legislative work in earnest, voting on several key pieces of legislation during its fifth week of Committee hearings.

For instance, the Senate Health Policy Committee passed a bill that would prohibit the use of tanning beds by minors, while the Government Operation Committee was the second committee to vote in favor of a Pediatric Cardiac Take Force. Wednesday saw traditional opponents coming together, as doctors and nurses agreed on a bill that would allow ARNPs to order controlled substances in a hospital environment pursuant to physician orders, and dentists and dental assistants agreed on a bill that would expand dental care to underserved areas.  All parties in the Senate joined together to advance a needle Exchange bill, although the legislation faces an uphill battle in the House.

For physicians, the most important issue Wednesday was the House Insurance and Banking Committee's consideration of the issue of balance billing.  While HB 221, as filed, is not worthy of support, leaders appeared to recognize the subtleties of the issue, including the need to ensure network adequacy.  The actual bill, along with several proposed amendments, likely will be heard on December 2.  On a positive note, the House Select Committee on Access to Healthcare unanimously advanced its Direct Primary Care Bill that would allow physicians to contract directly with patients for services, as well as legislation that would allow ASC patients to stay in such facilities for a full 24 hours.

With only one more week of pre-Session Committee meetings, the pace in Tallahassee has increased substantially, and we look forward to a tumultuous but productive first week of December.


Committee Week 3 Update

The January start of the 2016 Legislative Session means that our advocacy efforts are already in full swing.

Already the Advocacy Team has been representing the Society at a plethora of Committee hearings, with the House Health Quality Committee passing a Needle Exchange Bill (HB 81) , and the Senate Health Policy Committee passing a Hospital Prescribing "glitch bill" (SB 152) that allows ARNPs in a hospital environment to provide controlled substances in accordance with a physician's orders.  The latter bill is especially important, as it shows that, despite "agreeing to disagree" on issues such as independent practice, political rivals can unite behind good, common-sense legislation.  Let us hope that legislators themselves can do the same.

In addition, Lobbyist Chris Nuland met last week with the Department of Health Legislative Team in order to share intelligence and ensure that lines of communication remain open this Session.  While DOH is precluded from taking positions on particular pieces of legislation, the Department's input is vital to the process, and we look forward to continued interaction over the next several months.

Thank you, in advance, to all those members who take time to be part of the process, whether it be by interacting with the Society or legislators themselves.  Your voices are the most important part of the process, so keep those calls and emails coming!


Committee Week 2 Update
October 2015

The calendar may say that it is only October, but the legislative season is in full swing, with the Florida Legislature just having completed the second of six scheduled "committee weeks" in advance of the 2016 Session.

For the FGS, the obvious highlight of the week was Senator Eleanor Sobel's commitment to sponsor our Colon-Rectal Cancer Screening Bill.  While the Bill certainly will face stiff opposition in the House of Representative, we are pleased to have the Ranking Member of the Senate Health Policy Committee as our sponsor.

While the actual committee hearings were uneventful, lobbyists and legislators alike were scurrying to form alliances, file bills, and obtain intelligence regarding likely initiatives.  For us, many of last year's issues will re-emerge, as legislation has already been filed that would allow for Direct Primary Care, 24 hour ASC access, ARNP and PA prescribing, and the prohibition of most ER balance billing.

In addition to the legislative activity, the Florida Board of Medicine also met.  Not only did the Board review its usual caseload of disciplinary files, but it also continued its discussion of appropriate Level I procedures, who may perform advanced office procedures, and rules governing Telemedicine.  While no final decisions were made on these issues, early indications are that the direction of the discussions is consistent with our policies.

Next week is an "off" week for the Legislature, after which a three week Special Session on Redistricting will be held.  Although the focus of the Special Session will be on congressional and state senate maps, the health care committees will be meeting throughout the period, so stay tuned for what should be an eventful 21 days!!


6/17/15

End of Special Session Report

After the abrupt end of the 2015 Legislative Session, hope was high that the June Special Session could yield not only a balanced budget, but also resolution on a series of health care issues, all of which were included in the “call” for the Session.

True to its promises, the Florida House of Representatives not only considered the Senate’s Medicaid expansion plan, but also passed its own Health Care Reform package, including Direct Primary Care, ARNP/PA Prescribing, Certificate of Need Elimination, 24 Hour Ambulatory Surgery Centers and the Establishment of Recovery Care Centers.  While these initiatives all passed with overwhelming support, the House’s decision not to accept the Senate’s Medicaid expansion (on a mostly party-line vote) seriously jeopardized the Senate’s willingness to accept any House proposals.

Senator Aaron Bean graciously agreed to hear these proposals in his Health Policy Committee, but after a workshop on these issues, the Chairman decided that these issues were complicated enough to merit a vetting greater than that available in a three week special session.  As a result, the proposals died in the Senate Health Policy Committee, although Chairman Bean called for special interim workshops to more fully evaluate the proposals.  They will all be back when the Legislature begins its Committee hearings this Fall.

Despite these disappointments, the Legislature did succeed in its two major missions, to pass a balanced budget and appropriate enough finds for LIP funding.  With the use of $450 million dollars from General Revenue, as well as a $1 billion grant from the federal government, the Legislature was able to ensure continuation of LIP funding for one more year, after which time the federal government will further reduce its share of the cost by another $400 million.

In addition to the actions of the Legislature, the Governor provided some good news for FPHA and its members when he signed several of FPHA’s Priority Bills during June, including bills to ease HIV testing requirements (HB 321), allow the DOH to respond appropriately to epidemic threats (HB 697), and allow practitioners to provide opioid overdose counter-measures.

Overall, it has been an eventful six month legislative season, and it all revs up again in September due to the early start of Session in 2016.  I, for one, cannot wait!

As always, it is a pleasure an honor to serve.

CHRIS NULAND


4/10/15

Week Six Legislative Update

With the House concluding its committee meetings for the Session, the House Health and Human Services Committee took the opportunity to advance several pieces of controversial legislation.

The good news is that the Committee did pass HB 7047, which will allow many physicians to contract privately with patients for an annualized price without having to procure and insurance license. As a special bonus, the bill was amended to include a Medical Tourism component that will promote Florida medical expertise outside of the Sunshine State. This bill now mirrors SB 7084, which passed the Senate Health Policy Committee this week.

Other news from the Committee was not so favorable. Over our strenuous objections, the Committee passed HB 641 (which prohibits balance billing of emergency room patients under PPO contracts) and HB 547 (which would grant independent practice rights to ARNPs). While we will fight these proposals on the House floor and in the Senate, these issues likely will be in play up until the final moments of the Session.

This week's special thanks go to Representatives Gayle Harrell and Julio Gonzalez, M.D., both of whom worked closely with us in support of our legislative agenda and both of whom were kind enough to extend personal support to me during a tense week.

CHRIS NULAND

4/2/15

Week Five Legislative Update

As in most years, Week Five was devoted to further narrowing the range of bills that will be considered in the upcoming weeks. While significant action was taken on many of our priorities, other legislation lagged and is now in danger of "dying" in the respective committees of reference.

On a positive front, bills promoting Direct Primary Care and the responsible use of Telemedicine all are advancing and may be considered next week.

In less favorable news, despite our objections both the House Health Services Council and Senate Regulated Industries Committees advanced legislation that would allow ARNPs and Physician Assistants to prescribed controlled substances, albeit under physician protocols. Meanwhile, the House Health Services Committee advanced legislation that would prohibit Emergency Room Balance Billing of PPO patients, although the companion Senate legislation was tabled (at least temporarily) in the Senate.

CHRIS NULAND

3/30/15

Week Four Legislative Update

Four weeks of the 2015 Legislative Session are now in the books. With House Subcommittee meetings having now ended, and it becoming clearer where the major issues will arise during the final days of the Session.

This week was eventful, as the Senate Health Policy Committee passed the Health Care Clinic Act, as well as a bill designed to prevent managed care abuses. Activity in the House was not as fruitful, as the House Health Quality Committee passed a bill that would allow ARNPs and PAs independent practice, although we were pleased to see the House Criminal Justice Committee pass a bill to regulate the recreational drug, Kratom.

It has become evident that the House will continue its push to limit reimbursement of ER services, allow ARNPs and PAs to have greater autonomy, and prevent any expansion of Medicaid. Meanwhile, the Senate also is seeking limits on ER payments, but is much slower on extender expansion and is seeking to expand Medicaid so as to qualify Florida for public funds. At this point, we expect all of these issues to still be debated in the final hours of the Session.

Despite next week being the Passover/Easter week that usually is taken off by Legislature, the relatively late date of Passover will allow for an unusual flurry of activity, as ER balance billing bills likely will be heard in both the Senate and House next Tuesday. Please take this opportunity to contact members of the Senate Banking and Insurance Committee and the House Appropriations Committee to oppose these bad bills. Also on tap for Tuesday are a series of bills designed to decrease the deadly combination of texting and driving.

With the Session approaching its halfway point, it looks like it is going to be a wild ride for the last 30 days.

CHRIS NULAND

3/19/15

Week Three Legislative Update

It was the best of times.  It was the worst of times.

Week 3 of this year’s Legislative session featured the biggest battles yet for Medicine.  While the results were mixed, none of the actions taken this week were conclusive, and the fight will continue for another 42 days (but who is counting?).

The week began, as always, with a meeting of FMA and Specialty Society Lobbyists.  This is a crucial part of the week, as intelligence is shared and battle strategies are formulated.  With so many big issues, this week, this type of coordination is essential, and the behind-the-scenes lobbying against Scope of Practice Expansion and Restrictions on ER Billing began in earnest.

Tuesday’s Senate Health Policy Committee provided the first battle, as we objected to SB 614, which would allow ARNPs and Physician Assistants to prescribe controlled substances.  After vigorous debate, the proposal was supported by the Committee on a 4-3 vote.

Wednesday
, however, was the biggest day of the Session to date, starting with 7:00 a.m. meetings with our allies on the House Insurance and Banking Committee, which then considered HB 681 which, as written, could cap what a physician could charge for emergency procedures at 100% of the Medicare rate.  We objected strongly to this bill and supported amendments (which we drafted late Tuesday night) that would have retained the physician’s ability to bill the usual, customary, and reasonable fees for such services.  In the end, however, the bill passed on a 10-3 vote and now heads to the Appropriations Committee.  On a positive note, the Committee did approve an exemption to the Florida Insurance Code that would allow many physician to enter into private, capitated payment plans directly with patients.
That Committee was immediately followed by the Health Innovation Committee, which passed HB 1305, which will allow physicians to dispense home health equipment without a home health license.  The biggest issue, however, was HB 547, which would allow ARNPs and Physician Assistants to practice without physician supervision.  While the initial projections showed us losing that fight, the debate went in our favor, and the Chairman ultimately opted to table the bill when it became evident that we had the votes to defeat the proposal.

After all of the combativeness, Thursday’s major issue was one of consensus, as all stakeholders agreed that the current regulations on pain management clinics should become permanent.

All in all, it was an exhausting week, but we cannot wait to get back into the battle on Monday.

CHRIS NULAND

3/6/15

Week One Legislative Update

And away we go!!!

The 2015 Legislative Session began on Tuesday with the traditional State of the State speech by Governor Scott.  Instead of a full day of pleasantries, however, the House of Representatives immediately began its business in earnest, with the House Health Appropriations Committee quickly passing HB 411, which should better enable nursing homes to administer pneumonia vaccines.  Later that same afternoon, the House Innovation Committee heard testimony on  Direct Primary Care bill and opted to introduce it as HB 7047 later that day.

Wednesday was a day of immense activity, with the Senate Banking and Insurance Committee unanimously passing senator Don Gaetz’ Step Therapy Bill (SB 784), while the House Health Quality Committee was passing the Needle Exchange Pilot Program (HB 475), Increased Authority for the Surgeon General to Respond to Public Health Threats (HB 497), and Reauthorization of the State’s Pain Clinic Law (HB 4017).

Next week already is filling up with major issues.  On Tuesday morning at 9:00 a.m. the House Insurance and Banking Committee likely will debate HB 681, which would prevent emergency providers from balance billing patients.  This bill will jeopardize the availability of on-call providers and inadequately compensate those who do accept such responsibilities.  Any physician who would like to testify is urged to contact me, and we can get you on the schedule.

Also on Tuesday, the Senate Health Policy Committee will consider the Senate version of the Epidemic Response Bill (SB 950), as well as legislation to provide sovereign immunity to those providers serving the State.

As you can tell, it has been and will be a busy Session . Thank you to all for your support and, (with apologies to Governor Scott), “Let’s Get to Work.”

 

CHRIS NULAND