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From FAHU Lobbyist, Rhett O'Doski
2016 Week 5 Legislative Update
Week five is in the books and we have reached the halfway point in the 60 day 2016 legislative session. With much of the focus now turning toward crafting a state budget, here’s a look at where we stand on the priority legislation we have been following.
Out of network balance billing – SB 1422 by Garcia and HB 221 by Trujillo would prohibit balance billing consumers in PPO plans. Both bills are facing heavy opposition but we have been supporting both bills as they move through the committees. SB 1442 will be heard next in the Senate Banking and Insurance committee.
Step Therapy/Prior Authorization – SB 1084 by Gaetz, SB 676 by Grimsley and HB 963 by Harrison all would seek to prohibit health plans and pharmacy benefit managers from these utilization protocols that lower drug benefit prices. This has been a priority of the organized physicians for a few years in a row now. Although we have for most part killed the House bill, the Senate measures continue to advance and I expect as usual we will be fighting to kill them till the last day of the session.
Tamper resistant opioids – SB 422 by Benaquisto and HB 363 by Nunez would create a false market for expensive pain killers that purport to be tamper resistant. Although none of these drugs have been approved by the FDA, the bills would seek to require coverage by health insurance policies in certain circumstances. We have been working with the bill sponsors to narrow the scope of the coverage requirements and will continue to oppose the bills.
Family glitch – SB by Braynon and HB 543 by Starke – The Senate bill has run into heavy opposition in the Senate mostly by staff who believe the current statute is clear and that the Office of Insurance Regulation should clarify if not. The House bill has only one more committee stop before going to the floor and we are continuing to try to work out a solution for the Senate. More to come….
Agent fee/Public adjuster issue – We are working with CFO Atwater’s office on an amendment that would allow an agent to charge a fee in lieu of receiving a commission in the individual market. We are also working to fix a current glitch in the public adjuster statute that inadvertently classifies health agents as public adjusters during the course of assisting a policy holder. This is a joint effort with NAIFA-FL.
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Other Issues of Interest
State data shows more than 6000 died waiting on services
State data shows more than 6,000 poor, disabled, or elderly Floridians who qualified for home- and community-based health services died during a 12-month period while they were on waiting lists for those services, according to Christine Sexton of Politico.
According to statistics provided by the Department of Elder Affairs, 6,538 people died during the 2014-15 fiscal year while they were on a waiting list for one of four programs aimed at keeping the elderly out of nursing homes.
A spokesman for AARP said his association is aware of the high numbers of people who die, because they often hear about it from their members.
"This is a tragedy for this to happen as often as it’s happening," said Dave Bruns, the communications director for AARP Florida. "Florida is falling further and further behind."
Bruns stressed that the AARP is grateful for the additional funding the Legislature has directed toward the programs, which added an additional 812 slots to the Home and Community Care for the Elderly program.
House budget committee passes balance billing
The House Appropriations Committee unanimously approved a bill barring health providers from issuing the remainder of medical bills not paid by insurers under certain circumstances Feb. 9, 2016.
HB 221 Prohibits balance billing consumers with PPO health insurance plans under two scenarios:
“The first scenario is in an emergency room situation. The second is an inpatient scheduled procedure at an approved in-network hospital,” said bill sponsor Rep. Carlos Trujillo, R-Miami.
Rep. John Wood, R-Winter Haven, who chairs the House Insurance & Banking Subcommittee, said he would be pushing for additional changes at the bill’s last stop -- the Health & Human Services Committee.
“The original CS bill came out of the committee in which I was chair and it was clear at the committee hearing in the insurance committee that all of the presenters and all of the stake holders were absolutely clear that the consumer should be protected 100 percent,” Wood said.
Florida among states showing a drop in uninsured
Eight states saw a significant drop last year in the number of residents going without health insurance, according to a Centers for Disease Control and Prevention report out Feb. 9, according to The Associated Press.
They are Arizona, California, Colorado, Florida, Illinois, Kentucky, Michigan, and New York.
In addition to the eight states with statistically significant coverage gains, the report named another 10 with notable reductions in the percentage of uninsured residents. However, the changes in these states did not meet the survey's test for statistical significance.
The report focuses on ages 18 through 64 as they are more likely to be uninsured. Nationally, for all ages, the uninsured rate was 9.1 percent -- but 0.6 percent for 65 and over and 4.5 percent for 17 and under. The 18-64 national rate was 12.9 percent.
Florida’s rate was 11.8 percent for all ages and 17.8 percent for 18 through 64 year-olds. But the Sunshine State saw a 5.2 percent drop from the previous year for that age group.
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KidCare expansion passes final house committee
The House Health & Human Services Committee passed a bill Feb. 4 to remove the five-year waiting period for children of legal immigrants in Florida to be eligible for health care coverage through the Florida Kidcare Program.
HB 89, which has the vocal support of House Speaker Steve Crisafulli, now heads to the chamber floor.
A child of parents who legally immigrated to the United States from Cuba, Rep. Jose Felix Diaz became emotional during his closing remarks on the bill, reports Christine Sexton of Politico.
"We run for office. We make a lot of promises and this process is tough. And a lot of good bills die, but you can’t relent,” Diaz said, choking back tears. “You have to do things you believe in without fears of consequence. Handling a bill that deals with immigration is not easy. ”
There are about 17,000 children who will benefit if the ban is lifted. HB 89 includes an appropriation of nearly $300,000 which will draw down more than $28.5 million in federal funds to provide the care.
A similar Senate counterpart (SB 248) has one more committee stop.
Senate bill boosts rural hospitals
A Senate committee Tuesday approved a bill that could help boost efforts to build new or replacement hospitals in rural counties, according to The News Service of Florida.
Approved by the Senate Health Policy Committee, SB 236 would expand an exemption to the state's "certificate of need" regulatory process for hospital construction or expansion projects. The state currently has a narrow exemption that applies to hospitals in counties with populations of 15,000 to 18,000 people and densities of fewer than 30 people per square mile.
Bill sponsor Denise Grimsley, R-Sebring, said the current exemption applies to five hospitals in 11 counties. The bill would change the criteria to apply to counties with populations of fewer than 100 people per square mile, which Grimsley said would apply to 19 additional hospitals.
The certificate-of-need process is highly controversial, and House leaders have pushed to eliminate it completely. It often leads to legal battles between hospitals about construction or expansion plans. Grimsley's bill, however, is more limited.
Health transparency bill passes second committee
A bill requiring greater access to health care price and quality information passed its second House panel Monday after being amended.
HB 1175 requires the Agency for Health Care Administration to contract with a vendor for an “all-payer claims database” which provides a searchable website for consumers on price and quality.
A $4 million appropriation was tagged to the bill to pay for AHCA to contract with a vendor to build the Web platform to display data.
The only concern expressed was that the Health Care Cost Institute (HCCI) may be the only vendor qualified under the current bill language.
The governor’s office said it supported the bill and "looks forward" to continuing to work with the Legislature during the committee.
Having passed the House Health Care Appropriations Subcommittee, the bill moves to the Health & Human Services Committee.
House telehealth bill passes second committee
The House Health Care Appropriations Subcommittee unanimously passed its chamber's proposal on telehealth after agreeing to changes Feb. 8, 2016.
HB 7087 is the more the "ambitious" proposal moving through the Legislature this session, according to Christian Caballero, president of the Telehealth Association of Florida.
The Senate bill (SB 1686) defines telehealth, clarifies scope of practice and establishes a taskforce charged with gathering data from stakeholders and subsequently issuing a report on its findings, Caballero said.
"In addition to providing definitions and scope of practice language, the House version would allow healthcare practitioners licensed in other states (but not in Florida) the opportunity to go through an expedited application process that would enable them to practice telehealth in Florida," he wrote. "Floridians would be given the opportunity to choose from a larger pool of healthcare practitioners."
The committee agreed to two amendments from bill sponsor Rep. Chris Sprowls, R-Palm Harbor.
The first amendment makes a Department of Health survey a condition of licensure renewal.
The second amendment provides about $275,000 to hire four people at the Department of Health to review applications.
Florida short more than 12,000 nurses
A new report by the Florida Center for Nursing shows that there are 12,493 vacant registered nursing positions across the state, according to Kathleen McGrory of The Tampa Bay Times.
Nursing shortages have come and gone for decades. But there's reason to believe this one could be a prolonged problem. Observers are particularly troubled because the number of vacancies has increased more than 30 percent since 2013, according to the report. Compounding the problem, another 9,947 nursing positions are expected to be created in 2016.
"We're entering turbulent waters," said Dianne Morrison-Beedy, dean of the University of South Florida College of Nursing. "It's no longer like a tide coming in. It's a nursing shortage tsunami."
Hospitals, where nearly 75 percent of the statewide vacancies are located, are doing what they can to ensure nursing shifts are covered. Some are offering more overtime to nurses who volunteer to work extra hours. Others are increasing their use of contract nurses.
Morrison-Beedy said she applauds the work hospitals are doing to recruit and retain top nurses. But she believes it will take more to address the shortage in the long term.
"We have to think about what primes the pump, and that is the nursing colleges," she said.
Morrison-Beedy said nursing colleges across the state don't have the capacity to keep up with the statewide demand for nurses. They are especially short when it comes to faculty members with doctoral degrees, she said.
"Long-term solutions have to focus on faculty," she said.
Willa Fuller, executive director of the Florida Nurses Association, said policy makers and hospital executives also should consider compensation. The average annual mean wage for a registered nurse in Florida was $62,720 in 2014, according to the U.S. Bureau of Labor Statistics. By comparison, it was $66,570 in Pennsylvania, $77,110 in New York and $98,400 in California.
The Florida Legislature has also modified how the Board of Nursing oversees nursing education programs and has seen the number of programs increase by 116 percent, according to a recent report by its Office of Program Policy Analysis & Government Accountability (OPPAGA).
And individual lawmakers are pushing legislation that may attract out-of-state nurses by joining a multistate licensing compact and increasing their scope of practice.
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