Advocacy

    2020 LEGISLATIVE SESSION

    Week Five ending February 14

    The 90-day Legislative Session reached the half-way mark this week.  Lawmakers have less than four weeks to finish their work in time for the March 13 Sine Die.

    On Wednesday, the House Health and Human Services Committee considered HB 7039, a bill that repeals advisory bodies and programs that have been deemed inactive or unnecessary and are no longer beneficial to the furtherance of a public purpose. During that meeting, an amendment was offered to repeal the Pediatric Cardiac Technical Advisory Panel (PCTAP) that was created last session for the purpose of developing procedures and standards for measuring outcomes of pediatric cardiac catheterization programs and pediatric cardiovascular surgery programs.  On a voice vote, committee members approved the amendment after hearing the explanation that the PCTAP had completed its work and was no longer needed.  However, this is certainly not the case as the panel is legislatively charged – among other things - with annually submitting a report to the Governor, the President of the Senate, the Speaker of the House of Representatives, the Secretary of Health Care Administration, and the State Surgeon General summarizing the panel’s activities during the preceding fiscal year.  The report shall include data and performance measures on surgical morbidity and mortality for all pediatric cardiac programs.

    In working with FCACC member Monica Sanford, BC- ACNP, who was appointed to serve on the PCTAP, we have been able to draw attention to this issue in an effort to prevent the panel from being dissolved. Additionally, we have reached out to a number of legislators including the Senate bill sponsor, Senator Dennis Baxley who has agreed to not accept that amendment on his bill.  In addition, Senate Health Policy Chair Gayle Harrell has also been alerted and she will assist in opposing this effort. We are also working closely with the Florida Academy, American Academy of Pediatrics and others who are assisting in fighting this repeal.

    Several other developments this week include: 

    The consideration of a newly filed proposed committee bill (HMR-4) that would regulate vaping shops in Florida. The House Committee on Health Market Reform presented legislation that creates a retail nicotine products dealer permit which must be obtained from the State to sell nicotine products in Florida. Nicotine products and nicotine dispensing devices are not included in the definition of tobacco products. Retailers that sell only nicotine products and nicotine dispensing devices are not required to obtain a tobacco retailer permit or a permit from any other state agency. As such, these retailers are not subject to state regulatory oversight. The American Cancer Society, the American Heart Association and the American Lung Association all spoke out against this legislation during the committee meeting.  They support, as does the FCACC, the Senate version, SB 810, that includes nicotine under the definition of tobacco products and prohibits the sale to persons under 21. 

    The FMA and pharmacists reached an agreement on the consultant pharmacists legislation SB 1094. Part of the agreement requires that a medical director would remain in charge of directing the patient’s care.

    The House and Senate approved their budget proposals for the 20-21 Fiscal Year and are expected to begin the Budget Conference process soon.  Both proposals are recommending more than the $90.98 billion budget for the current year The House is proposing a $91.37 billion budget; the Senate - $92.83 billion.  The health care portion of the budget – specifically hospital funding is one of the major areas that lawmakers will have to iron out before a final agreement can be reached.  The Senate wants to shift $57.3 million that is targeted to hospitals that provide the most Medicaid services and direct a portion of it to increasing base Medicaid rates for all hospitals.  Meanwhile, the House’s budget would maintain hospital spending at current-year rates.

    Recap of Week four: February 10-14, 2020:

    Public Records and Meetings/Interstate Medical Licensure Compact

    SB 0928 – Harrell; SENATE Favorable by Governmental Oversight and Accountability; 5 Yeas, 0 Nays.

    The bill exempts from public inspection and copying requirements the personal identifying information of a physician, other than the physician’s name, licensure status, or licensure number, obtained from the coordinated information system under the Interstate Medical Licensure Compact, as defined in s. 456.4501, F.S., and held by the Department of Health (DOH) or the Board (the Board of Medicine or the Board of Osteopathic Medicine). This information is not exempt from public records requirements under the bill if the state originally reporting the information to the coordinated information system authorizes disclosure of such information by law.

    Consultant Pharmacists 

    SB 1094 – Diaz; SENATE Favorable with CS by Health Policy; 10 Yeas, 0 Nays.

    Based upon a compromise agreement with the FMA, the revised bill expands the scope of practice of professional pharmacists to include:

      • Ordering and evaluating of any laboratory testing;
      • Ordering and evaluating any clinical testing;
      • Conducting patient assessments;
      • Modifying, discontinuing, or administering medicinal drugs pursuant to s. 465.0125, F.S.; and
      • Conducting “other pharmaceutical services,” which includes, among other things, reviewing and making recommendations regarding the patient’s drug therapy and health care status to a patient’s prescribing physician, podiatrist, or dentist regarding the patient’s drug therapy and health care status.

    The bill authorizes a consultant pharmacist to enter into a written collaborative practice agreement (CPA) with a health care facility, medical director, or Florida-licensed physician, podiatrist, or dentist, who is authorized to prescribe medication. The bill also expands the locations where, under a CPA, a consultant pharmacist may offer his or her services, to include:

      • Ambulatory surgery center;
      • Inpatient hospice;
      • Hospital;
      • Alcohol or chemical dependency center;
      • Ambulatory care center; or
      • Nursing home component of a continuing care facility.

    Nicotine Products 

    Proposed Committee Bill (PCB) HMR4 - Health Market Reform Subcommittee; HOUSE   Submitted as Committee Bill and Reported Favorably by Health Market Reform; 14 Yeas, 1 Nay (The PCB will be re-numbered as a HB and will receive committee referrals)

    PCB HMR 20-04 creates a retail nicotine products dealer permit which must be obtained from the Division to sell nicotine products in this state. This establishes state regulatory oversight for retailers of nicotine products and nicotine dispensing devices. The bill also authorizes a holder of a tobacco retail permit to sell nicotine products in addition to tobacco products. The bill increases the punitive damages cap for manufacturers of vapor-generating electronic devices, nicotine products, or nicotine dispensing devices to the greater of four times the amount of compensatory damages or $2 million.

    Patient Safety Culture Surveys 

    HB 0763 - Grant (M); HOUSE Favorable by Health Care Appropriations Subcommittee; 10 Yeas, 0 Nays.

    The bill requires hospitals and ambulatory surgical centers (ASCs) to use the Hospital Survey on Patient Safety Culture (SOPS) to conduct patient safety culture surveys of facility staff. The facility must conduct the survey biennially, and submit the data to AHCA, in a format specified by rule. The bill requires the facility to conduct the survey anonymously to encourage staff employed by or working in the facility to complete the survey. The bill authorizes a hospital or ASC to contract to administer the survey, and to develop an internal action plan to identify survey measures to improve upon between surveys, which may be submitted to AHCA.

    The bill requires AHCA to collect, compile, and publish patient safety culture survey data submitted by hospitals and ASCs. The bill requires AHCA to publish the survey results for each facility, in the aggregate, by composite measure, and by unit work areas. AHCA must designate the use of updated versions of the survey as they occur. The bill requires AHCA to customize the survey to include questions that will generate certain data, including, data on the likelihood of a respondent to seek care for the respondent, and for the respondent’s family, at the surveying facility, both in general and within the respondent’s specific unit or department.

    The bill exempts from public inspection and copying requirements the personal identifying information of a physician, other than the physician’s name, licensure status, or licensure number, obtained from the coordinated information system under the Interstate Medical Licensure Compact, as defined in s. 456.4501, F.S., and held by the Department of Health (DOH) or the Board (the Board of Medicine or the Board of Osteopathic Medicine). This information is not exempt from public records requirements under the bill if the state originally reporting the information to the coordinated information system authorizes disclosure of such information by law.

    The bill also requires AHCA to customize the survey to allow a respondent to identify themselves as working in certain areas of a hospital or ASC that are not currently identifiable in the survey, including, a pediatric cardiology patient care unit and a pediatric cardiology surgical services unit.

    Use of Genetic Information 

    SB 1564 - Stargel; SENATE Favorable with CS by Judiciary; 6 Yeas, 0 Nays. 

    As amended, the bill provides that a life insurer or long-term care insurer may not cancel, limit, or deny insurance coverage or establish different insurance rates based on the “genetic information” of applicants. This same prohibition applies to health insurers under current law. The bill expressly provides that a statute regulating the use of genetic information for insurance purposes does not prevent life insurers from accessing an applicant’s medical record as part of an application exam and does not prevent life insurers from considering medical diagnoses included in the medical record.

    Prohibited Acts by Health Care Practitioners 

    HB 0309 - Massullo, Jr.; HOUSE Favorable with CS by Health & Human Services Committee; 17 Yeas, 0 Nays.

    The bill prohibits a health care practitioner from knowingly using certain names or titles if the health care practitioner is not authorized under the law to practice as an allopathic physician, osteopathic physician, podiatric physician, dentist, or chiropractic physician. The bill requires DOH to issue a notice to cease and desist to a practitioner who violates the bill’s provisions. If the health care practitioner does not correct the violation, DOH must issue an order imposing a citation and daily fine, reprimand or letter of concern, or suspension of license.

    Administration of Vaccines 

    HB 0825 - Fernandez-Barquin; HOUSE Favorable by Health & Human Services Committee; 17 Yeas, 0 Nays.

    The bill authorizes qualified Florida-licensed pharmacists or registered pharmacy interns to administer any CDC-recommended vaccine or vaccine licensed for use in the United States by the U.S. Food and Drug Administration to an adult. The bill also authorizes pharmacists to provide influenza vaccines to individuals age 7 and older. The bill repeals the Board of Pharmacy’s rulemaking authority to add vaccines to the list of vaccines that a pharmacist may administer. It also repeals the specific statutory limitation to the 2015 CDC-recommended vaccines.

    Physician Referrals 

    HB 0955 – Shoaf; HOUSE Favorable by Health & Human Services Committee; 16 Yeas, 1 Nay. Placed on Calendar, on 2nd reading.

    The bill prohibits a health care provider from referring patients to any hospital in which the health care provider holds an investment interest. This eliminates the special exception in the law for hospitals and an individual or entity that participates in any such referral may now also be subject to the anti-kickback and felony patient brokering statutes. The bill also requires health care providers to give a written notice to a patient any time the health care provider refers a patient to a provider not covered by the patient’s insurance.

    Patient Access to Records 

    HB 1147 – Payne; HOUSE Favorable by Health & Human Services Committee; 12 Yeas, 3 Nays. Placed on Calendar, on 2nd reading.

    The bill allows patients, residents and legal representatives to control how they receive requested records. Health care providers and facilities may produce the requested records in paper or electronic format, upon request. However, health care providers and facilities must produce the requested records in an electronic format, including access through a web-based patient portal or submission into a patient’s electronic personal health record, if the health care provider or facility maintains an electronic health recordkeeping system. The bill also standardizes access to treatment records for patients, residents and legal representatives, excluding nursing homes residents, predominantly utilizing elements of existing law or rule. It standardizes the timeframe that health care providers and facilities must produce records or allow inspection of records. All health care practitioners and facilities must provide records within 14 days of a request. The bill also requires health care facilities and providers to allow inspection of records within 10 days.

    Price Transparency in Health Care Services 

    HB 1205 - Rodriguez (Ant); HOUSE Favorable with CS by Health & Human Services Committee; 17 Yeas, 0 Nays. 

    The bill prohibits a health insurer from limiting a health care provider’s ability to disclose whether a patient’s cost-sharing obligation under his or her health insurance exceeds the cash price for a covered service. In addition, insurers must not prevent providers from communicating the availability of more affordable services to insured patients. The bill also prohibits an insurer from requiring an insured patient to make a payment for a health care service that exceeds the cash price of that service in the absence of health insurance.

    Keep Our Graduates Working Act

    HB 0115 – Duran; Substituted for SB 0356; SENATE Read Third Time; Passed (Vote: 35 Yeas / 1 Nay).  Bill goes to the Governor for final action.

    The bill:

      • Prohibits any state authority, including DOH, from denying the issuance of, refusing to renew, suspending, or revoking a professional license based solely on the licensee being delinquent on a payment of or defaulting on his or her student loans;
      • Removes the specific provision allowing DOH to discipline a health care practitioner for failing to repay a student loan and the associated mandatory discipline;
      • Repeals the requirement that DOH must issue an emergency order suspending a health care practitioner’s license for a student loan default, absent timely proof of a new repayment plan; and
      • Repeals the requirement that DOH must obtain a monthly list from the USHHS of the health care practitioners who have defaulted on their student loans.

    EARLY VIEW ON ISSUES UP NEXT WEEK

    During the first part of Session, the Senate provides a three-day notice for committee meeting agendas; while the House provides only a two-day notice.

    Monday 2/10/20

    Senate Governmental Oversight and Accountability 1:30PM-3:30PM              

    SB 1124 Legislative Review of Occupational Regulations - Diaz 

    SB 1836 Health Insurance and Prescription Drug Coverage - Bean 

    Senate Community Affairs 4pm-6pm

    SB 1636 Repeal of Advisory Bodies and Councils - Baxley 

    Tuesday 2/11/20

    Senate Health Policy 10am-12noon

    SB 0714 Testing for and Treatment of Influenza and Streptococcus Hutson 

    Wednesday 2/12/20

    House SESSION 1:30PM – N/A

    HB 0599 Consultant Pharmacists Rodriguez (AM) 

    HB 0959 Medical Billing - Duggan


    2020 TALLAHASSEE FLY-IN

    The FCACC has a strong presence in the state capital where we meet with lawmakers and work with other like-minded organizations to support legislation.  Members from all over the state came to the Capitol to meet lawmakers.  We met elected officials who influence health care policy and tell them our stories from the trenches - what the real impact of bills are on our practices and patients. 

    TALLAHASSEE
    The FCACC has a strong presence in the state capital where we meet with lawmakers and work with other like-minded organizations to support legislation. Our goal is to be the source of knowledge for cardiovascular health information.  Updates on bills we follow in session are posted on this page along with update on activities in the Capital.
    Click here to find your Florida Senators and Representatives.
     
    WASHINGTON, DC
    Although a state chapter, the FCACC has an impact and voice at the Federal level. Working in concert with the other 49 chapters of the ACC and with Heart House leaders and staff we have a network of contacts with our Congressional delegation. If you would like to serve as a key contact email jennifer@accfl.org. Key contacts sit down with lawmakers in-district and in Washington to explain in detail the impact of bills on our patients and profession and form a relationship with our lawmakers and their staff.

    ADVOCACY COMMITTEE

    Charge: The Advocacy Committee is charged with advocating for CV medicine and communicating with the lawmakers and regulators of Florida on issues relating to improving the cardiovascular health of all Floridians and to promoting access to quality cardiovascular care in Florida.
     
    David Kenigsberg, MD, FACC, Chair, Plantation

    Support HR 3107
    HR 3107 is  the bipartisan “Improving Seniors’ Timely Access to Care Act,” which would bring about necessary reforms to the prior authorization process within Medicare Advantage plans. The Florida Chapter supports the bill - go to this link and send your lawmakers a message to support the legislation.  
    The legislation specifically:
    • Creates a “real-time” electronic prior authorization process, developed by the Secretary of HHS, for items and services that are routinely approved;
    • Improves transparency by requiring plans to report to CMS on the extent of their use of prior authorization and the rate of approvals or denials;
    • Requires plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage to minimize any disruption in care;
    • Holds plans accountable for making timely prior authorization determinations and to provide rationales for denials;
    • Prohibits additional prior authorization for medically-necessary services performed during a surgical or invasive procedure that already received, or did not initially require prior authorization.




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